2014年 · 第127卷第24期

Dietary surveys suggest that a considerable proportion of the population fail to consume recommended amounts of calcium in both developing and developed countries. Recommended allowance for dietary calcium has attracted many controversies and there are discrepant opinions on how to meet the recommendations in the global scientific community。

Abstract：Background We aimed to improve the sensitivity of immunochemical fecal occult blood test (I-FOBT) to screen colorectal neoplasm among average-risk adults.Methods This is a diagnostic cohort study.All health examination participants receiving a single qualitative I-FOBT and a screening colonoscopy from January 2010 to June 2011 were included.Stool specimens were collected for I-FOBT before colonoscopy.Using pathology as gold standard,significant colorectal neoplasm was defined as advanced adenoma or malignancy.Results A total of 1 007 health examinees were identified.Fifty-five (5.5％) had borderline positive (+/-) I-FOBT,while 38 (3.8％) had positive I-FOBT.Twenty-four (2.4％) had advanced adenoma,and five (0.5％) had carcinoma.Using borderline positive I-FOBT as cutoff value,the sensitivity and specificity for significant colorectal neoplasm were 34.5％ (95％ confidence interval (CI) 19.9％-52.7％) and 91.5％ (95％ Cl89.6％-93.1％),respectively.If combined with advanced age,high blood pressure (BP),and abdominal obesity,a fulfillment of either two criteria further increased the sensitivity to 72.4％ (95％ Cl54.3％-85.3％) with a specificity of 68.8％ (95％ Cl65.8％-71.6％).Conclusion The sensitivity of a single qualitative I-FOBT for the detection of significant colorectal neoplasm can be increased by coupling with age,BP,and abdominal obesity。

Abstract：Background The management of Barcelona Clinic Liver Cancer (BCLC) stage B hepatocellular carcinoma (HCC) is controversial due to the early recurrence after curative hepatectomy,and many variables were related to the prognosis.The purpose of this study was to predict the tumor recurrence in early postoperative period of the patients with BCLC stage B HCC.Methods From January 2004 to January 2012,104 patients with BCLC stage B HCC underwent hepatectomy.Clinicopathological factors and follow-up data were statistically analyzed to establish a predicting scoring system.Results The overall survival rates for one,three,and five years were 69.2％,52.7％,and 42.3％,and the disease-free survival rates for one,three,and five years were 52.9％,47.3％,and 37.5％,respectively.The multiple factors analysis showed that the micro-vessel invasion,lymph nodes metastasis,multiple lesions,and the high expression of HMGB1 were independent factors (P ＜0.05).A scoring system was established to predict the early recurrence within one year after the surgery for BCLC stage B HCC,according to the analysis results with a specificity of 85.1％ and a sensitivity of 80.3％.Conclusion Variant clinicopathological factors were associated with early postoperative recurrence for BCLC stage B HCC and recurrence early after hepatectomy was more likely in patients with a higher score of the scoring system。

Abstract：Background The risk of HIV sexual transmission is much higher among people unaware of their HIV status than among those aware.Only a few studies have indicated that the incidence of unsafe sex can be reduced when people know their HIV status.This study was to investigate this effect in China.Methods A cohort study consisting of two surveys was conducted at two different times among a group of people living with HIV/AIDS,whose status was newly diagnosed with HIV via sexual contact,in Shanghai,Chongqing,and Kunming.The first survey was conducted among 823 people tested positive for HIV before notifying them of the HIV status.The second survey was conducted among 650 HIV-positive people at six months following the first survey (after notification of HIV status).The scope of survey covered unsafe sex practices,number of unsafe sexual partners,and frequency of unsafe sexual behaviors over the prior six months.Unsafe sex is defined as unprotected anal or vaginal sex with partners who are HIV positive or whose HIV status is unknown.Results The proportion of unsafe sex was reduced by about 85％ after HIV status notification.The risk of HIV sexual transmission was 15 times higher among persons unaware of their HIV status than among those aware.Approximately 95％ of new sexually transmitted HIV infections stemmed from 56％ of the infected persons unaware of their HIV status in China.Conclusion Timely HIV status notification has the potential to significantly reduce unsafe sex among HIV-infected persons and reduce the risk for HIV transmission via unsafe sex。

Abstract：Background Percutaneous nephrolithotomy (PCNL) was mostly performed with fluoroscopy and/or ultrasonography.The safety and feasibility of PCNL performed totally under ultrasound are not clearly defined.Therefore,we introduce the 9-year experience of 8 025 ultrasound guided PCNL procedures from multiple centers in China performed by the same surgeon,to evaluate the feasibility and security of this technique.Methods From September 2004 to August 2013,8 025 cases,4 398 males (54.8％) and 3 627 females (45.2％),whose age ranged from 6 months to 85 years old,with upper urinary tract stones,underwent PCNL in our center and the supported hospitals.Puncture site selection and channel dilation were all guided using only Doppler ultrasound.Single stones were treated in 1 356 cases,there were 2 817 cases of multi stones,and 3 852 cases of staghorn calculi.The pre-and post-operative imaging data,the intraoperative findings,operation time,perioperative complications,and related parameters were recorded.Results All procedures were successful.No patients died during the operation.Average operation time was 42 minutes (range 10 to 168 minutes),4 cases converted to open surgery,and 2 patients lost the diseased kidney due to refractory bleeding in the early stage of the PCNL.Ninety-four (1.2％) patients received blood transfusions and 20 (0.25％) patients needed highly selective renal artery embolization.Fifteen (0.19％) patients had a pleural injury.5 457 (68％) cases were completed by a single tract and 2 568 (32％) cases added more tracts.The mean stone size (longest diameter) was 2.8 cm (range 1.2 to 26.5 cm).The final stone-free rate was 85.5％.Residual stones occurred mainly in patients with renal dysfunction,medullary sponge kidney,and complete staghom calculi with a slim calyceal neck.Conclusions X-ray free Doppler ultrasound guided percutaneous nephrolithotomy is feasible and safe in a variety of cases of renal and/or upper ureteral stones.The probability of radiation hazard and adjacent organ injury is low.The morbidity from major complications was reduced remarkably after special training.It is worthy of wider use compared with fluoroscopy in patients with special kidneys (e.g.solitary kidney,spinal deformity,ectopic kidney) and in infants。

Abstract：Background Bardet-Biedl syndrome (BBS) is a genetically heterogeneous disease,and information about BBS in Chinese populations is very limited.The purpose of the present study was to determine the genetic cause of BBS in a Chinese Han family.Methods Clinical data were recorded for the 4-year-old female proband and the available family members.The proband was screened for mutation by Sanger sequencing for a total of 142 exons of the 12 BBS-causing genes (BBS1-BBS12).The variants detected in the proband were further confirmed in the other family members.Results We identified a novel homozygous nonsense mutation (c.70A＞T,p.K24X) in the BBS4 gene exon 2 in the proband.Such mutant allele was predicted to cause a premature truncation in the N-terminal of the BBS4 protein,and probably induced the nonsense-mediated decay of BBS4 messenger RNAs.The proband's parents and brother were heterozygous for the nonsense mutant allele.It was absent in 50 Chinese control subjects.An additional rare heterozygous missense single nucleotide polymorphism (SNP) named rs200718870 in BBS10 gene was also detected in the proband,her father and her brother.Some manifestations of the proband including atypical retinitis pigmentosa,choroidal sclerosis,high myopia,and early onset of obesity might be associated with this mutation in BBS4 gene.The proband's father also reported surgical removal of an extra finger during childhood.Conclusions The present study described a novel nonsense mutation in BBS4 gene in a Chinese family.This homozygous mutation was predicted to completely abolish the synthesis of the BBS4 protein.We also detected a rare heterozygous missense SNP in BBS10 gene in the family,but did not find sufficient evidence to support the triallelic inheritance。

Abstract：Background Attention deficit hyperactivity disorder (ADHD) is one of the most commonly diagnosed psychiatric disorder in childhood.ADHD children with overlapping symptoms and signs of motor problems have more serious prognosis than that of children with ADHD only.However,the motor and sensory processing problems in children with ADHD have not been studied well.Few people adopt the technique of computerized dynamic posturography (CDP) in the study of ADHD,which is applied widely in clinical and laboratory research to objectively evaluate human's balance performance.This study aimed to assess the characteristics of postural control and sensory information processing of boys with two subtypes of ADHD by using CDP,so as to provide the proof for non-drug therapy of ADHD.Method From June 2003 to September 2004,a total of 73 boys (7-15 years of age) with ADHD and 73 normal developing boys matched by age and intelligence quotient from Peking University Institute of Mental Health were recruited in the study.The Sensory Organization Test was adopted to test the static balance performance under six sensory input conditions by SMART EquiTest 8.0 (NeuroCom) instrument.The sensory information from three sensory systems were available under condition 1,the visual inputs were removed or distorted under condition 2 or 3,the somatosensory inputs were in conflict with or without the visual inputs removed under condition 4 or 5,and both the visual and somatosensory inputs were in conflict under condition 6.The indexes of equilibrium score,somatosensory,vestibular,and visual ratios,and strategy scores were analyzed to indicate the subjects' postural control ability.Results ADHD boys had significantly lower composite equilibrium score (CES) than the normal group (P ＜0.05).Under condition 1 and conditions 3-6,the equilibrium scores (ES) of the ADHD group were significantly lower (all P ＜0.05) than those of the control.Significantly lower visual and vestibular ratios and strategy scores under conditions 4-6 were found in boys with ADHD compared with the control group (P ＜0.05).Boys of ADHD-predominantly inattentive (ADHD-I) type had a significantly lower CES and ES under conditions 4-6 than the controls (all P ＜0.05) while the ESs of ADHD-combined type (ADHD-C) boys under each condition were similar with that of boys with ADHD-I and no significant difference was found between boys with ADHD-C and the control group (all P ＞0.05).Compared with the control group,the ADHD-I boys showed significantly lower visual and vestibular ratios and strategy scores under conditions 4-6 whereas the ADHD-C boys showed a trend of lower visual ratio (all P ＜0.05).Conclusions ADHD boys had a poorer static postural control ability and impaired function of processing visual and vestibular information compared with the normal control.Boys with ADHD-I showed particularly severe defect of static postural control and vestibular function integrating conflict information than normal boys.These deficits may be an important contributor to the clinical presentation of ADHD children and their cognitive deficits.Assessment and training of postural control function would be suggested during the diagnosis and treatment of ADHD children。

Abstract：Background Accumulating evidence indicates that systemic inflammation response is associated with the prognosis of various cancers.The aim of this study was to investigate the neutrophil-lymphocyte ratio (NLR),which is one of the systemic inflammation markers,in the prognosis of hepatocellular carcinoma (HCC) after treatment of transcatheter arterial chemoembolization (TACE).Methods The clinical data of 178 HCC patients who received TACE were retrospectively analyzed.The optimal NLR cutoff was determined according to the receiver operating characteristic (ROC) analysis.All patients were divided into NLR-normal group and NLR-elevated group according to the cutoff,and the clinical features of these two groups were comparatively analyzed.Meanwhile,the overall survival and disease free survival (DFS) were analyzed using the KaplanMeier method.The risk factors of postoperative survival were investigated using univariate and multivariate Cox regression analyses.Results The optimal NLR cutoff was defined at 1.85 and 42 (23.6％) patients had an elevated NLR (NLR＞1.85).The median survival time was 9.5 months (range 1-99 months).The clinical data between the two groups were comparable,except for α-fetoprotein.Follow-up results showed that the median survival of patients with normal NLR was 17.5 months (range:1-99 months) compared with 8 months (range:8-68 months) of patients with elevated NLR.The 1,3 and 5-year overall survival of patients in the NLR-normal group and NLR-elevated group were 57.3％,44.1％,and 27.2％ and 42.1％,19.6％,and 9.5％ respectively (x2=194.2,P ＜0.001).Similarly,the disease free survival also has a significant difference (x2=39.3,P ＜0.001).Multivariate Cox regression analysis showed that a high NLR was an independent factor affecting the survival rate of HCC after TACE (P=0.04).Conclusion Preoperative NLR was an important prognostic factor to predict the prognosis of patients with intermediate HCC treated with TACE。

Abstract：Background The left atrial appendage (LAA) is thought to be the main source of thrombi in patients with atrial fibrillation (AF).The purpose of this study was to describe the LAA orifice diameter,LAA length,and morphologic type of the LAA in Chinese patients with AF as well as to evaluate whether these LAA parameters are associated with a history of stroke in patients with AF from a single center in China.Methods The study population consisted of 219 consecutive patients with drug-refractory,symptomatic paroxysmal,or persistent AF scheduled to undergo radiofrequency catheter ablation in our single center.All patients underwent extensive clinical assessment and multidetector computed tomography to fully explore the anatomy of the LAA.Results Of the 219 patients who underwent catheter ablation procedures,chicken wing LAA morphology was found in 114 patients (52.2％),windsock in 52 (23.9％),cauliflower in 29 (13.0％),and cactus in 24 (10.9％).Compared with the windsock LAA morphology,cactus had a larger left atrial diameter ((42.40±3.68) and (37.91±4.32) mm,P=0.005) and LAA orifice diameter ((27.38±3.70) and (24.14±3.58) mm,P=0.048).The LAA length was significantly larger in the chicken wing morphology than in the windsock ((37.50±6.74) and (31.33±3.92) mm,P=0.015) and cauliflower morphologies ((37.50±6.74) and (31.33±3.92) ram,P=0.015).According to their medical records,26 patients (11.9％) had suffered a prior stroke.Compared with patients who had no history of stroke,the prior-stroke patients were older (62.04±8.07 and 58.24±9.24,P=0.047) and there were fewer patients with chicken wing (23.1％ and 59.1％,P=0.001) and more patients with cauliflower (26.9％ and 9.8％,P=0.046).Multivariate Logistic regression analysis demonstrated that age (odds ratio (OR) 1.26; 95％ confidence interval (CI) 1.08-1.47; P=0.003),non-chicken wing morphology (OR 5.82; 95％ Cl 1.61-21.03; P=0.007),and LAA orifice diameter (OR 1.25; 95％ Cl 1.05-1.49; P=0.014) were independent predictors of stroke after adjusting for all parameters that emerged as potential confounders with univariate analysis.Conclusion lAA analysis can potentially be used to inform guidance on the implication for stroke risk assessment。

Abstract：Background Spliceosome mutations have been recently identified and associated with hematological malignancies.SRSF2,one of components of the splicing machinery,has a high mutation frequency during chronic myelomonocytic leukemia,according to previous reports.However,the relevance of this finding in Chinese populations remains unknown.Methods We recruited 50 Chinese patients with chronic myelomonocytic leukemia to analyze the state of SRSF2 and to assess the corresponding clinical features by polymerase chain reaction followed by direct sequencing.Results Ten of 50 patients (20％) harbored SRSF2 mutations,including five P95R,two 95H,and three P95L point mutations.The patient group was older than the wild type group (P ＜0.01).No significant statistical differences were observed with regard to the other clinical characteristics (sex,peripheral blood count,serum lactate dehydrogenase,karyotype,World Health Organization classification,etc.) between these two groups.Two of the patients showed an early evolution to acute myeloid leukemia.Conclusions SRSF2 mutations are frequent in chronic myelomonocytic leukemia patients,but show a relatively lower incidence in Chinese patients.Moreover,the mutation can be related to old age and an unfavorable prognosis.Our results provide valuable insights for the development of a diagnostic marker,or for the identification of a therapeutic target for chronic myelomonocytic leukemia。

Abstract：Background Spinal cord injury (SCI) is a serious neurological injury that often leads to permanent disabilities for the victims.The aim of this study was to determine the effects of glial-derived neurotrophic factor (GDNF) mediated by recombinant adeno-associated virus type 2 (rAAV2) alone or in combination with early rehabilitation training on SCI.Methods SCI was induced on the T8-9 segments of the spinal cord by laminectomy in adult male Sprague-Dawley rats.Then besides the sham operation group,the SCI rats were randomly divided into four groups:natural healing group,gene therapy group,rehabilitation training group,and combination therapy group (gene therapy in combination with rehabilitation training).Motor dysfunction,protein expression of GDNF,edema formation,and cell injury were examined 7,14,and 21 days after trauma.Results The topical application of rAAV-GDNF-GFP resulted in strong expression of GDNF,especially after the 14th day,and could protect the motor neuron ceils.Early rehabilitative treatment resulted in significantly improved motor function,reduced edema formation,and protected the cells from injury,especially after the 7th and 14th days,and increased the GDNF expression in the damaged area,which was most evident after Day 14.The combined application of GDNF and early rehabilitative treatment after SCI resulted in a significant reduction in spinal cord pathology and motor dysfunction after the 7th and 14th days.Conclusion These observations suggest that rAAV2 gene therapy in combination with rehabilitation therapy has potential clinical value for the treatment of SCI。

Abstract：Background Chinese dietary reference intakes for calcium are largely based on foreign studies.We undertook metaregression to estimate calcium requirements for Chinese adults derived from calcium balance data in Chinese adults.Methods We searched PubMed,Cochrane CENTRAL,and SinoMed from inception to March 5,2014,by using a structured search strategy.The bibliographies of any relevant papers and journals were also screened for potentially eligible studies.We extracted a standardized data set from studies in Chinese adults that reported calcium balance data.The relationship between calcium intake and output was examined by an individual participant data (IPD) and aggregate data (AD) meta-regression.Results We identified 11 metabolic studies in Chinese adults within 18-60 years of age.One hundred and forty-one IPD (n=35) expressed as mg/d,127 IPD (n=32) expressed as mg·kg body wt-1·d-1,and 44 AD (n=132) expressed as mg/d were collected.The models predicted a neutral calcium balance (defined as calcium output (Y) equal to calcium intake (C)) at intakes of 460 mg/d (Y=0.60C+183.98) and 8.27 mg·kg body wt-1·d-1 (Y=0.60C+3.33)for IPD,or 409 mg/d (Y=0.66C+139.00) for AD.Calcium requirements at upper intakes were higher than that at lower intakes in all these models.Conclusion Calcium requirement for Chinese adults 18-60 years of age approximately ranges between 400 mg/d and 500 mg/d when consuming traditional plant-based Chinese diets。

Abstract：Objective To review the implications for diagnosis,pathogenesis and potential for new therapeutic option for chronic neutrophilic leukemia (CNL).Data sources Data cited in this review were obtained mainly from PubMed and Medline from 1993 to 2013 and highly regarded older publications were also included.The terms "chronic neutrophilic leukemia" and "diagnosis" were used for the literature search.Study selection We identified,retrieved and reviewed the information on the clinical and laboratory features,the new genetic findings,prognosis and disease evolution and management of CNL.Results The discovery of high-frequency granulocyte-colony stimulating factor receptor (CSF3R) mutations in CNL identifies a new major diagnostic criterion,and lends more specificity to the World Health Organization (WHO) diagnostic criteria for CNL,which are variably applied in routine clinical practice.Conclusions In patients for whom the cause of neutrophilia is not easily discerned,the incorporation of CSF3R mutation testing can be a useful point-of-care diagnostic to evaluate the presence of a clonal myeloid disorder,as well as providing the potential for genetically informed therapy.The oncogenic CSF3R mutations are molecular markers of sensitivity to inhibitors of the SRC family-TNK2 and JAK kinases and may provide a new avenue for therapy。

Abstract：Objective To discuss the rationale,hypothesis,modality of extracorporeal blood purification (EBP) techniques for the critically ill animal models or patients,and to summarize the experimental and clinical studies with inconsistent data which explored the EBP's efficacy in the areas of critical care medicine.Data sources Articles referred in this review were collected from the database of PubMed published in English up to June 2014.Study selection We had done a literature search by using the term "(sepsis OR acute lung injury OR acute respiratory distress syndrome) AND (extracorporeal blood purification OR hemofiltration OR hemoperfusion OR plasma exchange OR plasmapheresis OR adsorpiton)".Related original or review articles were included and carefully analyzed.Results Acute cellular and humoral immune disturbances occur in both sepsis and acute respiratory distress syndrome (ARDS).Treatments aimed at targeting one single pro-/anti-inflammatory mediator have largely failed with no proven clinical benefits.Such failure shifts the therapeutic rationale to the nonspecific,broad-spectrum methods for modulating the over-activated inflammatory and anti-inflammatory response.Therefore,EBP techniques have become the potential weapons with high promise for removing the circulating pro-/anti-inflammatory mediators and promoting immune reconstitution.Over the years,multiple extracorporeal techniques for the critically ill animal models or patients have been developed,including hemofiltration (HF),high-volume hemofiltration (HVHF),high-cutoff hemofiltration (HCO-HF),hemo-perfusion or-adsorption (HP/HA),coupled plasma filtration adsorption (CPFA),and plasma exchange (PE).These previous studies showed that EBP therapy was feasible and safe for the critically ill animal models or patients.However,data on their efficacy (especially on the clinical benefits,such as mortality) were inconsistent.Conclusions It is not now to conclude that EBP intervention can purify septic or ARDS patients with high clinical efficacy from current experimental and clinical practice.Prospective,randomized controlled,and well-designed clinical or experimental studies and most suitable EBP modalities should be further developed。

Abstract：Objective To investigate the current practice of myofascial pain syndrome (MPS) including current epidemiology,pathology,diagnosis and treatment.Data sources The data analyzed in this review were mainly from relevant articles without restriction on the publication date reported in PubMed,MedSci,Google scholar.The terms "myofasial trigger points" and "myofacial pain syndrome" were used for the literature search.Study selection Original articles with no limitation of research design and critical reviews containing data relevant to myofascial trigger points (MTrPs) and MPS were retrieved,reviewed,analyzed and summarized.Results Myofascial pain syndrome (MPS) is characterized by painful taut band,referred pain,and local response twitch with a prevalence of 85％ to 95％ of incidence.Several factors link to the etiology of MTrPs,such as the chronic injury and overload of muscles.Other factors,such as certain nutrient and hormone insufficiency,comorbidities,and muscle imbalance may also maintain the MTrP in an active status and induce recurrent pain.The current pathology is that an extra leakage acetylcholine at the neuromuscular junction induces persistent contracture knots,relative to some hypotheses of integration,muscle spindle discharges,spinal segment sensitization,ect.MTrPs can be diagnosed and localized based on a few subjective criteria.Several approaches,including both direct and supplementary treatments,can inactivate MTrPs.Direct treatments are categorized into invasive and conservative.Conclusion This review provides a clear understanding of MTrP pain and introduces the most useful treatment approaches in China。

Over the last 20 years, the application of non-invasive ventilation (NIV) in China has progressively increased both in the hospital and extrahospital setting. The history of the NIV and its increasing spread in the clinical practice over China are one of the most important results of the cooperation between medicine and non-invasive mechanic technology。

Assembled by the American College of Critical Care Medicine and well collaborated over six years, a 20-person task force with expertise developed updated guidelines for management of pain, agitation and delirium (PAD) in adult critically ill patients via reviewing, evaluating, and summarizing over 19 000 references. Beyond the regular revision of the "Clinical Practice Guidelines for the Sustained Use of Sedatives and Analgesics in the Critically Ill Adult" published in Critical Care Medicine in 2002,2 PAD guidelines generated valuable changes such as the analgesia-first concept, the light levels of sedation target, and early mobility for delirium prevention。

In recent years, "violent events against physicians" occurs frequently in China due to various reasons. They have been widely reported by Chinese and International media. Lancet recently published a couple of articles, entitled "Ending violence against doctors in China" in May 2012 and "Appeal from Chinese doctors to end violence" in November 2013. In early 2014 the BBC produced two reports about violence against physicians in China, and the Times Weekly raised the question "Why China's Doctors Are Getting Beat Up?", illustrating that engaging in frontline medical care in China is becoming a nightmare and disclosed the increasing harsh medical environment in China。

Phabdoid tumor of kidney (RTK) is a highly malignant tumor that occurs in infants and children, and approximately 80% of patients are diagnosed in the first two years of life. It was firstly described in 1978, and was defined as an independent disease in 1981. In the reported literatures, there were less in adolescents and extremely rare in adults. Here, we reported one case of RTK combined with metanephric adenoma, which was diagnosed and treated in the Third Affiliated Hospital, Sun Yat-sen University in 2012. In addition, the clinicopathological features, differential diagnosis and treatment of the primary RTK were also investigated with a review of the related Chinese literatures published from 2000 to 2012。

Medical humanity, as ambiguous and inclusive as the concept seems at first glance, is broadly defined as an interdisciplinary field in humanities, social science and the arts, involving such extensive fields as ethics, history, religion, cultural studies, sociology, psychology, literature, etc., and their application to medical education and practice.~ In the United States, Europe and Canada, many medical universities have integrated the learning of medical humanities in their curricula, which many scholars claim may help medical students to build up a humane and holistic orientation in the future。

To the editor: Corneal perforation requires an emergency surgical repair. Currently in China we do not have well-developed corneal bank, which makes it difficult for a surgeon to get gratis to perform emergency repair. Recent breakthrough in femtosecond laser (FS) technology has resulted in a novel "all-in-one" refractive procedure called refractive lenticule extraction (ReLEx).j A corneal stromal lenticule is removed during the procedure. We presented a surgical case of a large corneal perforation repaired with acellular glycerol-preserved multilayer comeal lamellar lenticules。

To the editor: We read the article Establishment of novel rat models for premah'gnant breast disease with great interest。

To the editor: Patient has a combination of two kinds of coronary anomalies, which is rare in congenital coronary artery anomalies.