MedNexus
2016年 · 第129卷第02期
出版日期 2016-01-20电子版 ￥0.00元
MedNexus
- 全部
- Editorial
- Original Article
- Review Article
- Perspective
- Clinical Practice
- Viewpoint
- Correspondence
- Author’s Reply
Editorial
开放获取
共享临床试验数据：国际医学期刊编辑委员会的提议Darren B Taichman, Joyce Backus, Christopher Baethge, Howard Bauchner, Peter W de Leeuw, Jeffrey M Drazen, John Fletcher, Frank Frizelle, Trish Groves, Abraham Haileamlak 等
中华医学杂志英文版2016年 129卷 02期
DOI: 10.4103/0366-6999.173420
摘要
国际医学期刊编辑委员会（ICMJE）认为，有道德义务负责任地分享干预性临床试验产生的数据，因为参与者将自己置于风险之中。越来越多的共识是，世界各地的许多资助者——基金会、政府机构和行业——现在要求数据共享。在这里，我们概述了ICMJE为帮助履行这一义务而提出的要求。我们鼓励对提议的要求进行反馈。任何人都可以在2016年4月18日之前通过www.icmje.org提供反馈。
Original Article
开放获取
“URSA复合物”在身体疲劳受试者中的疗效和安全性：一项多中心、随机、双盲、安慰剂对照试验Kwang-Min Kim, Moon-Jong Kim, Sang-Wook Song, Doo-Yeoun Cho, Kyung-Chae Park, Sung-Won Yang, Young-Sang Kim, Kyung-Soo Kim
中华医学杂志英文版2016年 129卷 02期
DOI: 10.4103/0366-6999.173432
摘要
Background:
Fatigue is a common symptom both in diseases status and in healthy subjects. Various supplements and nutraceuticals for relieving of fatigue have been used. However, there are a few studies to evaluate the efficacy and the safety of the drug for fatigue alleviation, we conducted using URSA Complex to evaluate the efficacy on physical fatigue via score changes in the checklist individual strength (CIS).
Methods:
The study was designed as a multicenter, randomized, double-blind, placebo-controlled trial, with subjects randomized to one of the two arms, receiving either placebo or URSA Complex administered as identical capsules. The primary efficacy endpoints of this clinical trials are the ratio of improving CIS scores < 76 points in patients at the end (4 weeks). Secondary efficacy variables are as follows one is an improvement of fatigue and the other is an improvement of the liver enzyme.
Results:
The fatigue recovery rate in who had improved CIS scores of < 76 points were 70.0%, 50.9% in the therapy group and placebo group, respectively (P = 0.019). The fatigue recovery rate in CIS score was higher in URSA Complex therapy group than placebo group. The difference between therapy group and placebo group was statistically significant at 4 weeks later, but not 2 weeks.
Conclusions:
Our results provided that the URSA Complex was effective in alleviating physical fatigue. The adverse event frequency in the therapy groups was similar to that in the placebo group.
开放获取
临床指南建议对疑似稳定型冠状动脉疾病患者冠状动脉计算机断层血管造影应用的影响Jia Zhou, Jun-Jie Yang, Xia Yang, Zhi-Ye Chen, Bai He, Luo-Shan Du, Yun-Dai Chen
中华医学杂志英文版2016年 129卷 02期
DOI: 10.4103/0366-6999.173434
摘要
Background:
Coronary computed tomographic angiography (CCTA) has been widely used in patients who are at intermediate risk for having stable coronary artery disease (SCAD), and 2013 European Society of Cardiology Guidelines on the Management of SCAD (2013G) recommended the appropriate application of CCTA. However, 2013G has not been subjected to systematic analyses for subsequent impact on clinical practice.
Methods:
A total of 5320 patients suspected with SCAD were enrolled and scheduled for CCTA from March 2013 to September 2014. For each patient, pretest probability of SCAD was calculated according to updated Diamond-Forrester model (UDFM). Appropriate CCTA or appropriate stress test was determined as described in the 2013G. A generalized estimating equation model was used to determine the trends in the half-monthly rate of appropriate CCTA.
Results:
Overall, only 61.37% of patients received appropriate CCTA, and there was insignificant change over time (P = 0.8701). The application of CCTA in patients who should have had a stress test accounted for most of the inappropriate CCTA before (22.29%) or after (19.98%) the publication of the 2013G. In all patients or any subgroup, no significant change in the adjusted half-monthly rate of appropriate CCTA was found after the publication of the 2013G (odds ratio, 1.002; 95% confidence interval, 0.982–1.021; P = 0.8678).
Conclusions:
These findings suggest that the 2013G have not, to date, been fully incorporated into clinical practice, and the clinical utilization of CCTA remains unreasonable to some extent.
开放获取
糖皮质激素和核黄素对迟发性多发性酰基辅酶A脱氢酶缺乏症患者疗效的历史队列研究Xin-Yi Liu, Zhi-Qiang Wang, Dan-Ni Wang, Min-Ting Lin, Ning Wang
中华医学杂志英文版2016年 129卷 02期
DOI: 10.4103/0366-6999.173438
摘要
Background:
Late-onset multiple acyl-CoA dehydrogenase deficiency (MADD) is the most common type of lipid storage myopathies in China. Most patients with late-onset MADD are well responsive to riboflavin. Up to now, these patients are often treated with glucocorticoids as the first-line drug because they are misdiagnosed as polymyositis without muscle biopsy or gene analysis. Although glucocorticoids seem to improve the fatty acid metabolism of late-onset MADD, the objective evaluation of their rationalization on this disorder and comparison with riboflavin treatment are unknown.
Methods:
We performed a historical cohort study on the efficacy of the two drugs among 45 patients with late-onset MADD, who were divided into glucocorticoids group and riboflavin group. Detailed clinical information of baseline and 1-month follow-up were collected.
Results:
After 1-month treatment, a dramatic improvement of muscle strength was found in riboflavin group (P < 0.05). There was no significant difference in muscle enzymes between the two groups. Significantly, the number of patients with full recovery in glucocorticoids group was less than the number in riboflavin group (P < 0.05). On the other hand, almost half of the patients in riboflavin group still presented high-level muscle enzymes and weak muscle strength after 1-month riboflavin treatment, meaning that 1-month treatment duration maybe insufficient and patients should keep on riboflavin supplement for a longer time.
Conclusions:
Our results provide credible evidences that the overall efficacy of riboflavin is superior to glucocorticoids, and a longer duration of riboflavin treatment is necessary for patients with late-onset MADD.
开放获取
拥抱试验：一种新的、敏感的冈上肌撕裂诊断试验Yu-Lei Liu, Ying-Fang Ao, Hui Yan, Guo-Qing Cui
中华医学杂志英文版2016年 129卷 02期
DOI: 10.4103/0366-6999.173461
摘要
Background:
The supraspinatus tendon is the most commonly affected tendon in rotator cuff tears. Early detection of a supraspinatus tear using an accurate physical examination is, therefore, important. However, the currently used physical tests for detecting supraspinatus tears are poor diagnostic indicators and involve a wide range of sensitivity and specificity values. Therefore, the aim of this study was to establish a new physical test for the diagnosis of supraspinatus tears and evaluate its accuracy in comparison with conventional tests.
Methods:
Between November 2012 and January 2014, 200 consecutive patients undergoing shoulder arthroscopy were prospectively evaluated preoperatively. The hug-up test, empty can (EC) test, full can (FC) test, Neer impingement sign, and Hawkins-Kennedy impingement sign were used and compared statistically for their accuracy in terms of supraspinatus tears, with arthroscopic findings as the gold standard. Muscle strength was precisely quantified using an electronic digital tensiometer.
Results:
The prevalence of supraspinatus tears was 76.5%. The hug-up test demonstrated the highest sensitivity (94.1%), with a low negative likelihood ratio (NLR, 0.08) and comparable specificity (76.6%) compared with the other four tests. The area under the receiver operating characteristic curve for the hug-up test was 0.854, with no statistical difference compared with the EC test (z = 1.438, P = 0.075) or the FC test (z = 1.498, P = 0.067). The hug-up test showed no statistical difference in terms of detecting different tear patterns according to the position (χ2 = 0.578, P = 0.898) and size (Fisher’s exact test, P > 0.999) compared with the arthroscopic examination. The interobserver reproducibility of the hug-up test was high, with a kappa coefficient of 0.823.
Conclusions:
The hug-up test can accurately detect supraspinatus tears with a high sensitivity, comparable specificity, and low NLR compared with the conventional clinical tests and could, therefore, improve the diagnosis of supraspinatus tears in clinical settings.
开放获取
缩窄性心包炎患者右心收缩功能对心包切除术预后的影响Xue Lin, Rui-Yi Xu, Jian-Zhou Liu, Wei Chen, Lian-Feng Chen, Peng-Hua Yang, Li-Gang Fang
中华医学杂志英文版2016年 129卷 02期
DOI: 10.4103/0366-6999.173463
摘要
Background:
To determine the influence of right ventricular function in patients with constrictive pericarditis (CP) undergoing surgery and to compare the outcomes of patients who received surgery with those managed medically.
Methods:
Patients with the diagnosis of CP and healthy volunteers were recruited from January 2006 to November 2011. Patients with CP chose to either receive pericardiectomy or medical management. Echocardiographic measurements were performed to evaluate heart function, and survival was recorded.
Results:
A total of 58 patients with CP (36 received pericardiectomy, 22 managed medically), and 43 healthy volunteers were included. CP patients who received surgery had a higher survival rate than those managed medically (P = 0.003), and higher survival was also seen in the subgroup of CP patients with severely impaired right systolic function. Albumin level, left ventricular end-diastolic dimension, and tricuspid regurgitation velocity were associated with survival in CP patients who received surgery.
Conclusions:
Preoperative right heart function does not affect surgical outcomes. Patients with severely impaired preoperative right systolic function obtain a greater survival advantage with surgery than with medical treatment.
开放获取
计算机导航辅助骶骨脊索瘤切除术Yong-Kun Yang, Chung-Ming Chan, Qing Zhang, Hai-Rong Xu, Xiao-Hui Niu
中华医学杂志英文版2016年 129卷 02期
DOI: 10.4103/0366-6999.173465
摘要
Background:
Resection of sacral chordomas is challenging. The anatomy is complex, and there are often no bony landmarks to guide the resection. Achieving adequate surgical margins is, therefore, difficult, and the recurrence rate is high. Use of computer navigation may allow optimal preoperative planning and improve precision in tumor resection. The purpose of this study was to evaluate the safety and feasibility of computer navigation-aided resection of sacral chordomas.
Methods:
Between 2007 and 2013, a total of 26 patients with sacral chordoma underwent computer navigation-aided surgery were included and followed for a minimum of 18 months. There were 21 primary cases and 5 recurrent cases, with a mean age of 55.8 years old (range: 35–84 years old). Tumors were located above the level of the S3 neural foramen in 23 patients and below the level of the S3 neural foramen in 3 patients. Three-dimensional images were reconstructed with a computed tomography-based navigation system combined with the magnetic resonance images using the navigation software. Tumors were resected via a posterior approach assisted by the computer navigation. Mean follow-up was 38.6 months (range: 18–84 months).
Results:
Mean operative time was 307 min. Mean intraoperative blood loss was 3065 ml. For computer navigation, the mean registration deviation during surgery was 1.7 mm. There were 18 wide resections, 4 marginal resections, and 4 intralesional resections. All patients were alive at the final follow-up, with 2 (7.7%) exhibiting tumor recurrence. The other 24 patients were tumor-free. The mean Musculoskeletal Tumor Society Score was 27.3 (range: 19–30).
Conclusions:
Computer-assisted navigation can be safely applied to the resection of the sacral chordomas, allowing execution of preoperative plans, and achieving good oncological outcomes. Nevertheless, this needs to be accomplished by surgeons with adequate experience and skill.
开放获取
甲状腺低分化癌与甲状腺乳头状癌的临床及超声特征比较Bo Zhang, Hui-Min Niu, Qiong Wu, Jiong Zhou, Yu-Xin Jiang, Xiao Yang, Jian-Chu Li, Rui-Na Zhao, Ming Wang, Kang-Ning Li 等
中华医学杂志英文版2016年 129卷 02期
DOI: 10.4103/0366-6999.173472
摘要
Background:
The clinical behavior and management of poorly differentiated thyroid carcinoma (PDTC) are very different from papillary thyroid carcinoma (PTC). By comparing the clinical and ultrasonographic features between the two tumors, we proposed to provide more possibilities for recognizing PDTC before treatment.
Methods:
The data of 13 PDTCs and 39 age- and gender-matched PTCs in Peking Union Medical College Hospital between December 2003 and September 2013 were retrospectively reviewed. The clinical and ultrasonic features between the two groups were compared.
Results:
The frequencies of family history of carcinoma, complication with other thyroid lesions, lymph node metastases, recurrent laryngeal nerve injuries, and distant metastases were higher in PDTCs (30.8%, 61.6%, 69.2%, 23.1%, and 46.2%, respectively) than those in PTCs (2.6%, 23.1%, 25.6%, 2.6%, and 2.6%, respectively) (P < 0.05). The mortality rate of PDTCs was greatly higher than PTCs (P < 0.01). Conventional ultrasound showed that the size of PDTCs was larger than that of PTCs (3.1 ± 1.9 cm vs. 1.7 ± 1.0 cm). Clear margins and rich and/or irregular blood flow were found in 92.3% of PDTCs, which differed substantially from PTCs (51.7% and 53.8%, respectively) (P < 0.05).
Conclusions:
PDTC is more aggressive and its mortality rate is higher than PTCs. Accordingly, more attention should be given to suspicious thyroid cancer nodules that show large size, regular shape, and rich blood flow signals on ultrasound to exclude the possibility of PDTCs.
开放获取
阿司匹林致胃粘膜损伤的临床及遗传危险因素研究Yun Wu, Ying Hu, Peng You, Yu-Jing Chi, Jian-Hua Zhou, Yuan-Yuan Zhang, Yu-Lan Liu
中华医学杂志英文版2016年 129卷 02期
DOI: 10.4103/0366-6999.173480
摘要
Background:
Current knowledge about clinical and genetic risk factors for aspirin-induced gastric mucosal injury is not sufficient to prevent these gastric mucosal lesions.
Methods:
We recruited aspirin takers as the exposed group and healthy volunteers as the control group. The exposed group was categorized into two subgroups such as subgroup A as gastric mucosal injury diagnosed by gastroscopy, including erosion, ulcer or bleeding of the esophagus, stomach, or duodenum; subgroup B as no injury of the gastric mucosa was detected by gastroscopy. Clinical information was collected, and 53 single nucleotide polymorphisms were evaluated.
Results:
Among 385 participants, 234 were in the aspirin-exposed group. According to gastroscopy, 82 belonged to subgroup A, 91 belonged to subgroup B, and gastroscopic results of 61 participants were not available. Using the Chi-square test and logistic regression, we found that peptic ulcer history (odds ratio [OR] = 5.924, 95% confidence intervals [CI]: 2.115–16.592), dual anti-platelet medication (OR = 3.443, 95% CI: 1.154–10.271), current Helicobacter pylori infection (OR = 2.242, 95% CI: 1.032–4.870), male gender (OR = 2.211, 95% CI: 1.027–4.760), GG genotype of rs2243086 (OR = 4.516, 95% CI: 1.180–17.278), and AA genotype of rs1330344 (OR = 2.178, 95% CI: 1.016–4.669) were more frequent in subgroup A than subgroup B. In aspirin users who suffered from upper gastrointestinal bleeding, the frequency of the TT genotype of rs2238631 and TT genotype of rs2243100 was higher than in those without upper gastrointestinal bleeding.
Conclusions:
Peptic ulcer history, dual anti-platelet medication, H. pylori current infection, and male gender were possible clinical risk factors for aspirin-induced gastric mucosal injury. GG genotype of rs2243086 and AA genotype of rs1330344 were possible genetic risk factors. TT genotype of rs2238631 and TT genotype of rs2243100 may be risk factors for upper gastrointestinal bleeding in aspirin users.
开放获取
定量环介导等温扩增导向靶向治疗医院获得性肺炎的初步研究Fang Wang, Ran Li, Ying Shang, Can Wang, Guo-Qing Wang, De-Xun Zhou, Dong-Hong Yang, Wen Xi, Ke-Qiang Wang, Jing Bao 等
中华医学杂志英文版2016年 129卷 02期
DOI: 10.4103/0366-6999.173484
摘要
Background:
It is important to achieve the definitive pathogen identification in hospital-acquired pneumonia (HAP), but the traditional culture results always delay the target antibiotic therapy. We assessed the method called quantitative loop-mediated isothermal amplification (qLAMP) as a new implement for steering of the antibiotic decision-making in HAP.
Methods:
Totally, 76 respiratory tract aspiration samples were prospectively collected from 60 HAP patients. DNA was isolated from these samples. Specific DNA fragments for identifying 11 pneumonia-related bacteria were amplified by qLAMP assay. Culture results of these patients were compared with the qLAMP results. Clinical data and treatment strategies were analyzed to evaluate the effects of qLAMP results on clinical data. McNemar test and Fisher’s exact test were used for statistical analysis.
Results:
The detection of Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa, Klebsiella pneumonia, Stenotrophomonas maltophilia, Streptococcus pneumonia, and Acinetobacter baumannii by qLAMP was consistent with sputum culture (P > 0.05). The qLAMP results of 4 samples for Haemophilus influenzae, Legionella pneumophila, or Mycoplasma pneumonia (MP) were inconsistent with culture results; however, clinical data revealed that the qLAMP results were all reliable except 1 MP positive sample due to the lack of specific species identified in the final diagnosis. The improvement of clinical condition was more significant (P < 0.001) in patients with pathogen target-driven therapy based on qLAMP results than those with empirical therapy.
Conclusion:
qLAMP is a more promising method for detection of pathogens in an early, rapid, sensitive, and specific manner than culture.
开放获取
不同饲料喂养烟雾性肺气肿大鼠血清脂联素的比较Rui-Ying Wang, Hu Liu, Li-Juan Ma, Jian-Ying Xu
中华医学杂志英文版2016年 129卷 02期
DOI: 10.4103/0366-6999.173486
摘要
Background:
Smoking and body mass index (BMI) are the key risk factors for chronic obstructive pulmonary disease (COPD). Adiponectin with both anti-inflammatory and pro-inflammatory properties is a vital modulator of inflammatory processes, which is expressed in epithelial cells in the airway in COPD-emphysema. The aim of this study was to examine the effects of adiponectin on tobacco smoke-induced emphysema in rats, which were fed different diets.
Methods:
Seventy-six adult (6–8 weeks old) male Sprague-Dawley rats (average weight 220 ± 20 g) were exposed to smoke or smoke-free room atmosphere and fed different diets (regular, high-fat, or low-fat diets) for 6 months. The rats were randomly divided into six groups. They are nonsmoke-exposed regular diet (n = 10), nonsmoke-exposed high-fat diet (n = 14), nonsmoke-exposed low-fat diet (n = 14), smoke-exposed regular diet (n = 10), smoke-exposed high-fat diet (n = 14), and smoke-exposed low-fat diet groups (n = 14). A full 23 factorial design was used to evaluate the effect of independent variables on smoke exposure and different rearing methods. Serum adiponectin and inflammatory cytokines were measured by the enzyme-linked immunosorbent assay (ELISA).
Results:
Serum adiponectin levels in rats fed low-fat and regular diets exposed to smoke exposure were remarkably higher than that of rats exposed to room air while serum adiponectin levels of fat-rich diet rats exposed to tobacco smoke were lower than that of rats exposed to room air. Compared with regular diet or low-fat diet group, serum adiponectin levels in high-fat diet rats exposed to tobacco smoke were lower (t = 6.932, 11.026; all P < 0.001). BMI was inversely correlated with serum adiponectin levels (r = −0.751, P = 0.012). Serum interleukin 6 (IL-6), tumor necrosis factor-α (TNF-α), and 4-hydroxy 2-nonenal (HNE) levels in rats exposed to low-fat or fat-rich diets were remarkably higher than that of rats exposed to normal diets (IL-6, t = 4.196, 3.480; P < 0.01, P = 0.001; TNF-α, t = 4.286, 3.521; P < 0.01, P = 0.001; 4-HNE, t = 4.298, 4.316; all P < 0.001). In nonhigh-fat diet rats exposed to tobacco smoke, serum adiponectin levels correlated positively with serum IL-6, TNF-α, and 4-HNE, bronchoalveolar lavage cell count, and mean linear intercept. In contrast, in high-fat diet rats, serum adiponectin levels correlated inversely with these parameters.
Conclusions:
In smoke-induced emphysema and fat-rich diet rat model, serum adiponectin level was decreased, and the anti-inflammatory effect was attenuated. By contrast, nonhigh-fat diet elevated serum adiponectin and enhanced the role of pro-inflammatory.
Review Article
开放获取
人工晶状体表面改性Qi Huang, George Pak-Man Cheng, Kin Chiu, Gui-Qin Wang
中华医学杂志英文版2016年 129卷 02期
DOI: 10.4103/0366-6999.173496
摘要
Objective:
This paper aimed to review the current literature on the surface modification of intraocular lenses (IOLs).
Data Sources:
All articles about surface modification of IOLs published up to 2015 were identified through a literature search on both PubMed and ScienceDirect.
Study Selection:
The articles on the surface modification of IOLs were included, but those on design modification and surface coating were excluded.
Results:
Technology of surface modification included plasma, ion beam, layer-by-layer self-assembly, ultraviolet radiation, and ozone. The main molecules introduced into IOLs surface were poly (ethylene glycol), polyhedral oligomeric silsesquioxane, 2-methacryloyloxyethyl phosphorylcholine, TiO2, heparin, F-heparin, titanium, titanium nitride, vinyl pyrrolidone, and inhibitors of cytokines. The surface modification either resulted in a more hydrophobic lens, a more hydrophilic lens, or a lens with a hydrophilic anterior and hydrophobic posterior surface. Advances in research regarding surface modification of IOLs had led to a better biocompatibility in both in vitro and animal experiments.
Conclusion:
The surface modification is an efficient, convenient, economic and promising method to improve the biocompatibility of IOLs.
Perspective
开放获取
颈动脉内膜中层厚度测量：与动脉粥样硬化、心血管疾病风险的关系及其在随机对照试验中的应用Michiel L Bots, Gregory W Evans, Charles H Tegeler, Rudy Meijer
中华医学杂志英文版2016年 129卷 02期
DOI: 10.4103/0366-6999.173500
摘要
心血管疾病（CVD）是全世界死亡的主要原因，并且对发病率有很大贡献。[
开放获取
中心静脉导管错位的表现与处理Lin Wang, Zhang-Suo Liu, Chang-An Wang
中华医学杂志英文版2016年 129卷 02期
DOI: 10.4103/0366-6999.173525
摘要
中心静脉导管（CVCs）通常用于获得各种临床适应症的血管通路。这些包括给药、肾脏替代治疗、全胃肠外营养、外周静脉通路不良、心导管插入术和经静脉心脏起搏。[
Clinical Practice
开放获取
肠重复囊肿误诊为梅克尔憩室Yee-Suk Kim, Dong-Ju Kim, Seung-Uk Bang, Jun-Jae Park
中华医学杂志英文版2016年 129卷 02期
DOI: 10.4103/0366-6999.173544
摘要
肠重复囊肿是一种非常罕见的先天性异常，症状包括腹痛、腹胀、肠出血和便血。便血可由胃粘膜异位引起，尽管婴儿便血还有其他原因；因此，肠重复囊肿可能被误诊为肠套叠或梅克尔憩室。本文报告一例被误诊为梅克尔憩室的肠重复囊肿。
开放获取
疑似埃博拉患者急腹症临床评估体会Guang Cao, Qing-Yu Kong, Bé Jean Kolie, Song Zhao
中华医学杂志英文版2016年 129卷 02期
DOI: 10.4103/0366-6999.173545
摘要
埃博拉病毒病(EVD)是由埃博拉属病毒种引起的急性出血性传染病E.病毒EVD可出现腹痛、呕吐、腹泻等胃肠道症状。该病致死率为30%~90%。[
Viewpoint
开放获取
疑似稳定型冠状动脉疾病的冠状动脉计算机断层血管造影：2013年欧洲心脏病学会指南建议与临床实践之间的差距Fu-Cheng Sun
中华医学杂志英文版2016年 129卷 02期
DOI: 10.4103/0366-6999.173548
摘要
冠状动脉计算机断层血管造影（CCTA）作为一种评估冠状动脉解剖结构的无创诊断技术，在临床上得到了广泛的应用。其优点包括对冠状动脉病变的存在和病变特征的诊断具有高敏感性和特异性，扫描时间短，患者辐射暴露低，患者可接受。CCTA诊断冠状动脉病变的敏感性和特异性在患者水平为83%~100%和70%~80%，在血管水平为83%~97%和93%~100%。对于大多数候选人来说，它可以在门诊进行。在患者量大的医院和大多数县医院，甚至更多的多层计算机断层扫描仪用于冠状动脉疾病（CAD）的筛查，但在CCTA之前没有用于CAD功能评估的压力测试设备。与其他成熟的非侵入性应激技术（包括应激运动心电图（ECG）、单光子发射计算机断层扫描（SPECT）和应激心脏超声心动图）相比，CCTA在治疗疑似CAD症状患者方面的规则在不同患者人群中仍未得到很好的研究。对典型、稳定或非典型心绞痛患者的评估通常遵循指南和基于临床研究证据的既定逐步方法。[
Correspondence
开放获取
急发性肥胖伴下丘脑功能障碍、通气不足和自主神经失调综合征的精神症状及其治疗1例Habib Erensoy, Mehmet Emin Ceylan, Alper Evrensel
中华医学杂志英文版2016年 129卷 02期
DOI: 10.4103/0366-6999.173550
摘要
致编者：伴有下丘脑功能障碍、通气不足和自主神经失调（ROHHAD）综合征的急发性肥胖是一种罕见疾病。它在儿童期（通常在3-4岁）被诊断出来。它影响内分泌、呼吸和自主神经系统。在不同的年龄表现出不同的症状。可见体重快速增加、肥胖、肺泡通气不足、高钠血症、心肺骤停、高催乳素血症、尿崩症、出汗过多、痛觉增加、阻塞性睡眠呼吸暂停、手/脚冰冷和消化运动障碍。肺泡通气不足对诊断至关重要。[
开放获取
伊拉克库尔德斯坦苏莱曼尼亚省白血病研究Zhala AA Karim, Karzan G Khidhir, Rebaz A Ahmed, Halgord A Hassan, Dana Omer Karim
中华医学杂志英文版2016年 129卷 02期
DOI: 10.4103/0366-6999.173551
摘要
致编辑：伊拉克几个城市白血病发病率的上升与接触贫化铀有关，贫化铀在随后的1990年至2010年伊拉克战争中被使用。[
开放获取
克罗恩病患者钝性创伤后大量便血：无腹腔积血的腔内出血Jung Soo Park, Jin Hong Min, Jun Ho Kang, Yong Nam In
中华医学杂志英文版2016年 129卷 02期
DOI: 10.4103/0366-6999.173552
摘要
致编者：一名29岁的女性在一次交通事故中作为乘客遭受腹部钝性创伤后1小时因便血被救护车送往急诊科。患者还患有克罗恩病（CD），到达时主诉腹痛和持续便血。体检时，她脸色苍白，心疼，收缩压90 mmHg，心率126次/分钟。血液常规检查显示血红蛋白水平为86克/升。她的收缩压最初对1.0 L静脉晶体激发有反应，但在30分钟内降至70 mmHg，与每个直肠失血进一步大量亮红色一致。便血也增加（可能是新鲜血液），血红蛋白水平降至68 g/L。患者接受了腹部计算机断层扫描（CT）和静脉注射造影剂。CT扫描显示横结肠有可疑的壁缺损，以及游离空气密度和结肠周围脂肪浸润[
开放获取
Rasmussen脑炎伴面臂肌张力障碍发作和双侧半球受累Jian-Hua Chen, Li-Ri Jin, Xiao-Hua Shi, Di Yang, Yi Guo
中华医学杂志英文版2016年 129卷 02期
DOI: 10.4103/0366-6999.173554
摘要
致编者：拉斯姆森脑炎（RE）是一种罕见但具有破坏性的单半球脑疾病，通常影响儿童，以顽固性癫痫发作和进行性神经功能缺损为特征。[
开放获取
后腹腔镜肾部分切除术治疗肾肾小球旁细胞瘤1例Zhong-Li Ma, Zhan-Kui Jia, Chao-Hui Gu, Jin-Jian Yang
中华医学杂志英文版2016年 129卷 02期
DOI: 10.4103/0366-6999.173555
摘要
致编者：一名32岁男性因右肾肿瘤在年度体检中被转诊至郑州大学第一附属医院。半年多前发现血压偏高，入院时为138/102mmHg。他没有高血压家族史。他的血清钾水平正常。我们没能检测他的血浆肾素活性。
开放获取
阻塞性睡眠呼吸暂停低通气综合征和肺栓塞：华法林与气道正压通气作为决定因素的比较Filipa Ramalho Fernandes, Dulce Apolinário, Antonio M Esquinas
中华医学杂志英文版2016年 129卷 02期
DOI: 10.4103/0366-6999.173556
摘要
致编辑：谢等人分析了华法林治疗阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者肺栓塞（PE）的剂量及其不良反应。主要发现是OSAHS患者比非OSAHS患者需要显著更高剂量的华法林（4.73 mg对3.61 mg，P<0.001），停用华法林后OSAHS组PE复发率高于非OSAHS组（21.43%对6.78%，P=0.047).他们得出结论，OSAHS患者在停止6个月华法林治疗后可能出现高凝状态和相对较高的PE复发风险。我们饶有兴趣地阅读了这篇文章。[
Author’s Reply
开放获取
阻塞性睡眠呼吸暂停低通气综合征：导致反复肺栓塞的隐姓埋名者？Xie Jiang, Liu Shuang, Wei Yong-Xiang
中华医学杂志英文版2016年 129卷 02期
DOI: 10.4103/0366-6999.173560
摘要
感谢您的阅读和对我们最近出版物的宝贵评论。[
本期目次
下载本期封面 下载本期目录
