MedNexus
2016年 · 第129卷第03期
出版日期 2016-02-05电子版 ￥0.00元
MedNexus
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Original Article
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肿瘤标志物在胸腔积液病因诊断中的临床价值Yan Gu, Kan Zhai, Huan-Zhong Shi
中华医学杂志英文版2016年 129卷 03期
DOI: 10.4103/0366-6999.174501
摘要
Background:
It is often challenging to distinguish tuberculous pleural effusion (TPE) from malignant pleural effusion (MPE); thoracoscopy is among the techniques with the highest diagnostic ability in this regard. However, such invasive examinations cannot be performed on the elderly, or on those in poor physical condition. The aim of this study was to explore the differential diagnostic value of carbohydrate antigen 125 (CA125), carbohydrate antigen 199 (CA199), carcinoembryonic antigen (CEA), neuron-specific enolase (NSE), and squamous cell carcinoma (SCC) associated antigen in patients with TPE and MPE.
Methods:
Using electrochemiluminescence, we measured the concentration of tumor markers (TMs) in the pleural effusion and serum of patients with TPE (n = 35) and MPE (n = 95). We used receiver operating characteristic (ROC) curve analysis to evaluate the TMs and differentiate between TPE and MPE.
Results:
The cut-off values for each TM in serum were: CA125, 151.55 U/ml; CA199, 9.88 U/ml; CEA, 3.50 ng/ml; NSE, 13.27 ng/ml; and SCC, 0.85 ng/ml. Those in pleural fluid were: CA125, 644.30 U/ml; CA199, 12.08 U/ml; CEA, 3.35 ng/ml; NSE, 9.71 ng/ml; and SCC, 1.35 ng/ml. The cut-off values for the ratio of pleural fluid concentration to serum concentration (P/S ratio) of each TM were: CA125, 5.93; CA199, 0.80; CEA, 1.47; NSE, 0.76; and SCC, 0.90. The P/S ratio showed the highest specificity in the case of CEA (97.14%). ROC curve analysis revealed that, for all TMs, the area under the curve in pleural fluid (0.95) was significantly different from that in serum (0.85; P < 0.001).
Conclusions:
TMs in TPE differ significantly from those in MPE, especially when detected in pleural fluid. The combined detection of TMs can improve diagnostic sensitivity.
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线粒体DNA A8701G突变与母系遗传高血压和扩张型心肌病的关系Ye Zhu, Xiang Gu, Chao Xu
中华医学杂志英文版2016年 129卷 03期
DOI: 10.4103/0366-6999.174491
摘要
Background:
Cardiovascular diseases, including dilated cardiomyopathy (DCM) and hypertension, are the leading cause of death worldwide. The role of mitochondrial DNA (mtDNA) in the pathogenesis of these diseases has not been completely clarified. In this study, we evaluate whether A8701G mutation is associated with maternally inherited hypertension and DCM in a Chinese pedigree of a consanguineous marriage.
Methods:
Fourteen subjects in a three-generation Han Chinese family with hypertension and DCM, in which consanguineous marriage was present in the parental generation, were interviewed. We divided all the family members into case (7 maternal members) and control group (7 nonmaternal members) for comparison. Clinical evaluations and sequence analysis of mtDNA were obtained from all participants. Frequency differences between maternal and nonmaternal members were tested to locate the disease-associated mutations.
Results:
The majority of the family members presented with a maternal inheritance of hypertension and DCM. Sequence analysis of mtDNA in this pedigree identified eight mtDNA mutations. Among the mutations identified, there was only one significant mutation: A8701G (P = 0.005), which is a homoplasmic mitochondrial missense mutation in all the matrilineal relatives. There was no clear evidence for any synergistic effects between A8701G and other mutations.
Conclusions:
A8701G mutation may act as an inherited risk factor for the matrilineal transmission of hypertension and DCM in conjunction with genetic disorders caused by consanguineous marriage.
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免疫抑制治疗后风湿性疾病患者巨细胞病毒肺炎：中国单中心研究Yu Xue, Li Jiang, Wei-Guo Wan, Yu-Ming Chen, Jiong Zhang, Zhen-Chun Zhang
中华医学杂志英文版2016年 129卷 03期
DOI: 10.4103/0366-6999.174490
摘要
Background:
Rheumatic diseases involve multiple organs that are affected by immunological mechanisms. Treatment with corticosteroids and immunosuppressive agents may also increase the frequency of infection. Cytomegalovirus (CMV) is a widespread herpes virus and a well-recognized pathogen, which causes an opportunistic and potentially fatal infection in immunocompromised patients. This retrospective study aimed to investigate the clinical and laboratory characteristics of CMV pneumonia in patients with rheumatic diseases after immunosuppressive therapy in a single center in Shanghai, China.
Methods:
Eight hundred and thirty-four patients with rheumatic diseases who had undergone CMV-DNA viral load tests were included, and the medical records of 142 patients who were positive for CMV-DNA in plasma samples were evaluated. GraphPad Prism version 5.013 (San Diego, CA, USA) was used to conduct statistical analysis. The correlation between CMV-DNA viral loads and lymphocyte counts was assessed using the Spearman rank correlation coefficient test. Significance between qualitative data was analyzed using Pearson’s Chi-squared test. The cut-off thresholds for CMV-DNA viral load and lymphocyte count were determined by receiver operating characteristic (ROC) curve analysis.
Results:
One hundred and forty-two patients had positive CMV viral load tests. Of these 142 patients, 73 patients with CMV pneumonia were regarded as symptomatic, and the other 69 were asymptomatic. The symptomatic group received higher doses of prednisolone (PSL) and more frequently immunosuppressants than the asymptomatic group (P < 0.01). The symptomatic group had lower lymphocyte counts, especially CD4+ T-cells, than the asymptomatic group (P < 0.01). By ROC curve analysis, when CD4+ T-cell count was <0.39 × 109/L, patients with rheumatic diseases were at high risk for symptomatic CMV infection. The CMV-DNA load was significantly higher in the symptomatic patients than that in asymptomatic patients (P < 0.01; threshold viral loads: 1.75 × 104 copies/ml). Seven patients had a fatal outcome, and they had lower peripheral lymphocyte counts (P < 0.01), including CD4+ and CD8+ T-cells (P < 0.01).
Conclusions:
When CD4+ T-cell count is <0.39 × 109/L, patients are at high risk for pulmonary CMV infection. Patients are prone to be symptomatic with CMV-DNA load >1.75 × 104 copies/ml. Lymphopenia (especially CD4+ T-cells), presence of symptoms, and other infections, especially fungal infection, are significant risk factors for poor outcome, and a higher PSL dosage combined with immunosuppressants may predict CMV pneumonia.
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硼替佐米治疗多发性骨髓瘤合并乙型肝炎患者的疗效和安全性：一项多中心回顾性研究Jin Lu, Wen-Ming Chen, Chuan-Ying Geng, Brian GM Durie, Xiao-Jun Huang
中华医学杂志英文版2016年 129卷 03期
DOI: 10.4103/0366-6999.174508
摘要
Background:
The efficacy and safety evidence of bortezomib in multiple myeloma (MM) patients with hepatitis B is vacant. This study aimed to investigate the efficacy and safety of bortezomib in MM patients with hepatitis B in China.
Methods:
From 2006 to 2011, 739 newly diagnosed MM patients were screened for serum hepatitis B virus (HBV) biomarkers. HBV-infected patients were followed for HBV reactivation by monitoring of serum alanine transaminase (ALT) and HBV DNA load. The pattern of HBV reactivation in relation to bortezomib was evaluated. Seven hundred thirty-nine MM patients were included in this study.
Results:
The prevalence of MM patients infected with HBV was 3.4% (n = 25), of which 17 cases were treated with bortezomib. Bortezomib had no significant influence on liver function (ALT before and after treatment: 36.69 ± 8.90 U/L vs. 11.31 ± 2.74 U/L, P = 0.19) and HBV DNA of MM patients with HBV (detectable HBV DNA percentage: 5.9% vs. 11.8%, P = 0.12).
Conclusions:
Bortezomib can be used safely and effectively in MM patients with hepatitis B. HBV prophylaxis and surveillance are recommended during the MM treatment.
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应激对女性首次抑郁发作患者脑灰质体积的非特异性影响Chuan-Jun Zhuo, Hai-Man Bian, Yan-Jie Gao, Xiao-Lei Ma, Sheng-Zhang Ji, Meng-Yuan Yao, Ning Zhai, Xin-Hai Sun, Xiao-Yan Ma, Hong-Jun Tian 等
中华医学杂志英文版2016年 129卷 03期
DOI: 10.4103/0366-6999.174494
摘要
Background:
This study aimed to observe the differences in brain gray matter volume in drug-naive female patients after the first episode of major depression with and without stressful life events (SLEs) before the onset of depression.
Methods:
Forty-three drug-naive female patients voluntarily participated in the present study after the first major depressive episode. The life event scale was used to evaluate the severity of the impact of SLEs during 6 months before the onset of the major depressive episode. High-field magnetic resonance imaging (MRI) scans were obtained, and the VBM and SPM8 software process were used to process and analyze the MRI.
Results:
Compared to that in patients without SLEs, the volume of brain gray matter was lower in the bilateral temporal lobe, right occipital lobe, and right limbic lobe in the SLE group. However, the gray matter volume did not differ significantly between the two groups after the application of false discovery rate (FDR) correction.
Conclusions:
Although the results of the present study suggest the absence of significant differences in brain gray matter volume between female drug-naive patients after the first episode of major depression with and without SLEs after FDR correction, the study provides useful information for exploring the definitive role of stress in the onset of depression.
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应用常规直线加速器实施宫颈癌恒剂量率恒角间距调强弧治疗Ruo-Hui Zhang, Xiao-Mei Fan, Wen-Wen Bai, Yan-Kun Cao
中华医学杂志英文版2016年 129卷 03期
DOI: 10.4103/0366-6999.174500
摘要
Background:
Volumetric-modulated arc therapy (VMAT) can only be implemented on the new generation linacs such as the Varian Trilogy® and Elekta Synergy®. This prevents most existing linacs from delivering VMAT. The purpose of this study was to investigate the feasibility of using a conventional linear accelerator delivering constant dose rate and constant angular spacing intensity-modulated arc therapy (CDR-CAS-IMAT) for treating cervical cancer.
Methods:
Twenty patients with cervical cancer previously treated with intensity-modulated radiation therapy (IMRT) using Varian Clinical 23EX were retreated using CDR-CAS-IMAT. The planning target volume (PTV) was set as 50.4 Gy in 28 fractions. Plans were evaluated based on the ability to meet the dose volume histogram. The homogeneity index (HI), target volume conformity index (CI), the dose to organs at risk, radiation delivery time, and monitor units (MUs) were also compared. The paired t-test was used to analyze the two data sets. All statistical analyses were performed using SPSS 19.0 software.
Results:
Compared to the IMRT group, the CDR-CAS-IMAT group showed better PTV CI (0.85 ± 0.03 vs. 0.81 ± 0.03, P = 0.001), clinical target volume CI (0.46 ± 0.05 vs. 0.43 ± 0.05, P = 0.001), HI (0.09±0.02 vs. 0.11 ± 0.02, P = 0.005) and D95 (5196.33 ± 28.24 cGy vs. 5162.63 ± 31.12 cGy, P = 0.000), and cord D2 (3743.8 ± 118.7 cGy vs. 3806.2 ± 98.7 cGy, P = 0.017) and rectum V40 (41.9 ± 6.1% vs. 44.2 ± 4.8%, P = 0.026). Treatment time (422.7 ± 46.7 s vs. 84.6 ± 7.8 s, P = 0.000) and the total plan Mus (927.4 ± 79.1 vs. 787.5 ± 78.5, P = 0.000) decreased by a factor of 0.8 and 0.15, respectively. The IMRT group plans were superior to the CDR-CAS-IMAT group plans considering decreasing bladder V50 (17.4 ± 4.5% vs. 16.6 ± 4.2%, P = 0.049), bowel V30 (39.6 ± 6.5% vs. 36.6 ± 7.5%, P = 0.008), and low-dose irradiation volume; there were no significant differences in other statistical indexes.
Conclusions:
Patients with cervical cancer treated with CDR-CAS-IMAT using Varian Clinical 23EX can get equivalent or superior dose distribution compared to those treated with IMRT. CDR-CAS-IMAT has a less treatment time and MU, which can reduce the uncertainty factor and patient discomfort in treatment.
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两种不同的全髋关节置换术治疗成人Hartofilakidis型发育不良Ya-Ming Chu, Yi-Xin Zhou, Na Han, De-Jin Yang
中华医学杂志英文版2016年 129卷 03期
DOI: 10.4103/0366-6999.174507
摘要
Background:
Total hip arthroplasty (THA) in developmental dysplasia of the hip (DDH) is more complex than the normal hip, with large replacement risks and many complications. Although nonosteotomy THA is convenient to perform, femoral osteotomy shortening can avoid blood vessel and nerve traction injuries. This study aimed to compare osteotomy THA with nonosteotomy to determine reasonable options for operative management of DDH.
Methods:
Data on 48 DDH patients who underwent THA were analyzed retrospectively. The patients were divided into two groups: Group A 29 cases (nonosteotomy), and group B 19 cases (osteotomy). Harris and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores, limb length discrepancy (LLD), radiological data on the hip, and claudication were evaluated. Data were analyzed by using paired-sample Student’s t-test, independent-sample Student’s t-test, and Pearson’s Chi-square test; the test level was α=0.05.
Results:
Postoperative Harris (90.7 ± 5.1) and WOMAC scores (88.0 ± 10.6) were significantly improved compared with preoperative Harris (44.8 ± 5.7) and WOMAC scores (42.0 ± 5.3) in group A (P < 0.05). Postoperative Harris (90.4 ± 2.8) and WOMAC scores (88.2 ± 5.9) were significantly improved compared with preoperative Harris (44.4 ± 4.2) and WOMAC scores (43.2 ± 4.3) in group B (P < 0.05). One case of dislocation occurred in group A; after closed reduction, dislocation did not recur. In group A, 2 patients developed cutaneous branch injury of the femoral nerve, which spontaneously recovered without treatment. Postoperative LLD >2 cm was seen in one case in group A and five cases in group B. Postoperative claudication showed no significant difference between the two groups (P > 0.05). No patients developed infection; postoperative X-rays showed that the location of the prosthesis was satisfactory, and the surrounding bone was not dissolved.
Conclusions:
THA is effective and safe for DDH. For unilateral high dislocation DDH patients with limb lengthening ≤4 cm and good tissue conditions, THA without femoral osteotomy may be considered.
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辅助性T细胞因子1和辅助性T细胞因子对人角质形成细胞丝聚蛋白及其加工蛋白酶表达的差异调节Zheng-Hong Di, Lei Ma, Rui-Qun Qi, Xiao-Dong Sun, Wei Huo, Li Zhang, Ya-Ni Lyu, Yu-Xiao Hong, Hong-Duo Chen, Xing-Hua Gao
中华医学杂志英文版2016年 129卷 03期
DOI: 10.4103/0366-6999.174489
摘要
Background:
Atopic dermatitis (AD) is characterized by defective skin barrier and imbalance in T helper 1/T helper 2 (Th1/Th2) cytokine expression. Filaggrin (FLG) is the key protein to maintaining skin barrier function. Recent studies indicated that Th1/Th2 cytokines influence FLG expression in keratinocytes. However, the role of Th1/Th2 cytokines on FLG processing is not substantially documented. Our aim was to investigate the impact of Th1/Th2 cytokines on FLG processing.
Methods:
HaCaT cells and normal human keratinocytes were cultured in low and high calcium media and stimulated by either interleukin (IL)-4, 13 or interferon-γ (IFN-γ). FLG, its major processing proteases and key protease inhibitor lymphoepithelial Kazal-type-related inhibitor (LEKTI) were measured by both real-time quantitative polymerase chain reaction and Western blotting. Their expression was also evaluated in acute and chronic AD lesions by immunohistochemistry.
Results:
IL-4/13 significantly reduced, while IFN-γ significantly up-regulated FLG expression. IL-4/13 significantly increased, whereas IFN-γ significantly decreased the expression of kallikreins 5 and 7, matriptase and channel-activating serine protease 1. On the contrary, IL-4/13 significantly decreased, while IFN-γ increased the expression of LEKTI and caspase-14. Similar trends were observed in AD lesions.
Conclusions:
Our results suggested that Th1/Th2 cytokines differentially regulated the expression of major FLG processing enzymes. The imbalance between Th1 and Th2 polarized immune response seems to extend to FLG homeostasis, through the network of FLG processing enzymes.
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替诺福韦和拉米夫定联合依法韦仑治疗中国人类免疫缺陷病毒和乙型肝炎病毒合并感染患者的疗效和安全性Ya-Song Wu, Wei-Wei Zhang, Xue-Mei Ling, Lian Yang, Shao-Biao Huang, Xi-Cheng Wang, Hao Wu, Wei-Ping Cai, Min Wang, Hui Wang 等
中华医学杂志英文版2016年 129卷 03期
DOI: 10.4103/0366-6999.174509
摘要
Background:
The prevalence of hepatitis B virus (HBV) infection is high among individuals infected with human immunodeficiency virus (HIV) in China. Both HIV and HBV can be treated with tenofovir disoproxil fumarate (TDF) and lamivudine (3TC), so we evaluated the safety and efficacy of combination antiretroviral therapy (ART) that included TDF, 3TC, and efavirenz (EFV) among ART-naive individuals who were co-infected with HIV and HBV.
Methods:
One hundred HIV/HBV co-infected ARV-naive individuals were started on the regimen of TDF, 3TC, and EFV, and the levels of plasma HBV DNA, HIV RNA, and biochemical evaluation related to the function of liver and kidney were analyzed.
Results:
Concerning efficacy, this study found that by week 48, the vast majority co-infected participants receiving this ART regimen had undetectable HBV DNA levels (71%) and/or HIV RNA levels (90%). Concerning safety, this study found that the median estimated glomerular filtration rate of participants decreased from baseline (109 ml∙min−1∙1.73 m−2) to week 12 (104 ml∙min−1∙1.73 m−2) but was almost back to baseline at week 48 (111 ml∙min−1∙1.73 m−2).
Conclusion:
This combination ART regimen is safe and effective for patients with HIV/HBV co-infection.
Trial Registration:
ClinicalTrials.gov, NCT01751555; https://clinicaltrials.gov/ct2/show/NCT01751555.
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中国健康青年男性下肢滑囊的高分辨率超声测量Yong-Yan Gao, Chi-Qiu Wu, Wei-Xing Liu, Lei Zhang, Chun-Ling Li
中华医学杂志英文版2016年 129卷 03期
DOI: 10.4103/0366-6999.174487
摘要
Background:
Lower extremity bursae are very vulnerable to injury during strenuous physical exercises. Understanding the imaging characteristics of normal bursae is essential for early diagnosis of morphological abnormalities. Therefore, we evaluated the normal range of lower extremity bursae in healthy young men using high-resolution ultrasound (HR-US) imaging.
Methods:
Bursae in the lower extremities were examined by HR-US in 290 Chinese healthy young men with a median age of 18 years (range, 18–23 years). The bilateral suprapatellar bursa (SPB), deep infrapatellar bursa (DIPB), popliteal bursa (PB), and retrocalcaneal bursa (RCB) were imaged and measured for analysis.
Results:
The HR-US identification rates of the SPB, DIPB, PB, and RCB were 89.0% (517/580), 55.0% (319/580), 29.4% (171/580), and 49.5% (287/580), respectively. With the assumption that the bursae were normal in 95% of the study participants, the length and width values at the maximal cross-section of the SPB, DIPB, PB, and RCB were ≤18.00 and 6.09 mm, 8.10 and 2.11 mm, 7.67 and 3.93 mm, and 7.82 and 2.04 mm, respectively.
Conclusions:
Using HR-US imaging, we were able to analyze lower extremity bursae with high detection rates in healthy young men. The normal ranges of lower extremity bursa dimensions in healthy young men measured by HR-US in this study could be used as reference values for evaluation of bursa abnormalities in the lower extremity.
Meta Analysis
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以沙利度胺为基础的老年和/或不适合移植的多发性骨髓瘤患者的荟萃分析Wen-Wen Lyu, Qing-Chun Zhao, De-Hai Song, Jin-Jie Zhang, Zhao-Xing Ding, Bao-Yuan Li, Chuan-Mei Wei
中华医学杂志英文版2016年 129卷 03期
DOI: 10.4103/0366-6999.174497
摘要
Background:
Thalidomide is an immunomodulatory and anti-angiogenic drug that has shown promise in patients with myeloma. Trials comparing efficacy of standard melphalan and prednisone (MP) therapy with MP plus thalidomide (MPT) in transplant-ineligible or elderly patients with multiple myeloma (MM) have provided conflicting evidence. This meta-analysis aimed to determine the efficacy and toxicity of thalidomide in previously untreated elderly patients with myeloma.
Methods:
Medline, the Cochrane Controlled Trials register, conference proceedings of the American Society of Hematology (1995–2014), the American Society of Clinical Oncology (1995–2014), and CBM, VIP, and CNKI databases were searched for randomized control trials with the use of the medical subject headings "MM" and "thalidomide". Trials were assessed by two reviewers for eligibility. Meta-analysis was conducted using a fixed effects model. Sensitivity analysis was performed to test the robustness of the findings.
Results:
Overall, seven trials were identified, covering a total of 1821 subjects. The summary hazard ratio (thalidomide vs. control) was 0.82 (95% confidence interval [CI]: 0.72–0.94) for overall survival (OS), and 0.65 (95% CI: 0.58–0.73) for progression-free survival, in favor of thalidomide treated group. The risk ratio of complete response with induction thalidomide was 3.48 (95% CI: 2.24–5.41). A higher rate of III/IV adverse events were observed in MPT arm compared with the MP arm. However, analysis of sub-groups administering anticoagulation as venous thromboembolism prophylaxis suggested no difference in relative risk of thrombotic events between two arms (RR = 1.47, 95% CI: 0.43–5.07, P = 0.54). Further analysis of trials on the treatment effects of MPT versus MP on adverse events-related mortality showed no statistical difference between two arms (RR = 1.24, 95% CI: [0.95–1.63], P = 0.120).
Conclusion:
Thalidomide appears to improve the OS of elderly and/or transplant-ineligible patients with MM when it is added to standard MP therapy.
Review Article
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循环纤维细胞在心肌纤维化中的作用Rong-Jie Lin, Zi-Zhuo Su, Shu-Min Liang, Yu-Yang Chen, Xiao-Rong Shu, Ru-Qiong Nie, Jing-Feng Wang, Shuang-Lun Xie
中华医学杂志英文版2016年 129卷 03期
DOI: 10.4103/0366-6999.174503
摘要
Objective:
It is revealed that circulating fibrocytes are elevated in patients/animals with cardiac fibrosis, and this review aims to provide an introduction to circulating fibrocytes and their role in cardiac fibrosis.
Data Sources:
This review is based on the data from 1994 to present obtained from PubMed. The search terms were "circulating fibrocytes" and "cardiac fibrosis" .
Study Selection:
Articles and critical reviews, which are related to circulating fibrocytes and cardiac fibrosis, were selected.
Results:
Circulating fibrocytes, which are derived from hematopoietic stem cells, represent a subset of peripheral blood mononuclear cells exhibiting mixed morphological and molecular characteristics of hematopoietic and mesenchymal cells (CD34+/CD45+/collagen I+). They can produce extracellular matrix and many cytokines. It is shown that circulating fibrocytes participate in many fibrotic diseases, including cardiac fibrosis. Evidence accumulated in recent years shows that aging individuals and patients with hypertension, heart failure, coronary heart disease, and atrial fibrillation have more circulating fibrocytes in peripheral blood and/or heart tissue, and this elevation of circulating fibrocytes is correlated with the degree of fibrosis in the hearts.
Conclusions:
Circulating fibrocytes are effector cells in cardiac fibrosis.
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三种小分子药物靶向治疗非小细胞肺癌的评价Jun Ni, Li Zhang
中华医学杂志英文版2016年 129卷 03期
DOI: 10.4103/0366-6999.174484
摘要
Objective:
To guide the optimal selection among first-generation epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) in clinical practice. This review attempted to provide a thorough comparison among three first-generation EGFR-TKIs, namely icotinib, erlotinib, and gefitinib, with regard to their molecular structure, pharmacokinetic parameters, clinical data, adverse reactions, and contraindications.
Data Sources:
An electronic literature search of the PubMed database and Google Scholar for all the available articles regarding gefitinib, icotinib, and erlotinib in the English language from January 2005 to December 2014 was used.
Study Selection:
The search terms or keywords included but not limited to "lung cancer", "nonsmall cell lung cancer (NSCLC)", "epidemiology", "EGFR", "TKIs", and "optimal selection".
Results:
As suggested by this review, even though the three first-generation EGFR-TKIs share the quinazoline structure, erlotinib had the strongest apoptosis induction activity because of its use of a different side-chain. The pharmacokinetic parameters indicated that both erlotinib and icotinib are affected by food. The therapeutic window of erlotinib is narrow, and the recommended dosage is close to the maximum tolerable dosage. Icotinib enjoys a wider therapeutic window, and its concentration in the blood is within a safe dosage range even if it is administered with food. Based on multiple large-scale clinical trials, erlotinib is universally applied as the first-line treatment. In marked contrast, icotinib is available only in China as the second- or third-line therapeutic approach for treating advanced lung cancer. In addition, it exhibits a similar efficacy but better safety profile than gefitinib.
Conclusions:
Although there is a paucity of literature regarding whether icotinib is superior to erlotinib, its superior toxicity profile, noninferior efficacy, and lower cost indicate that it is a better alternative for Chinese patients living with advanced NSCLC.
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异黄酮与前列腺癌：一些关键问题的综述Hong-Yi Zhang, Jie Cui, Ye Zhang, Zhen-Long Wang, Tie Chong, Zi-Ming Wang
中华医学杂志英文版2016年 129卷 03期
DOI: 10.4103/0366-6999.174488
摘要
Objective:
The purpose of this review is to discuss some critical issues of isoflavones protective against the development of prostate cancer (PCa).
Data Sources:
Data cited in this review were obtained primarily from PubMed and Embase from 1975 to 2015.
Study Selection:
Articles were selected with the search terms "isoflavone", "Phytoestrogen", "soy", "genistin", and "PCa" .
Results:
Isoflavones do not play an important role on prostate-specific antigen levels reduction in PCa patients or healthy men. The effect of isoflavones on sex hormone levels and PCa risk may be determined by equol converting bacteria in the intestine, specific polymorphic variation and concentrations of isoflavones. The intake of various types of phytoestrogens with lower concentrations in the daily diet may produce synergistic effects against PCa. Moreover, prostate tissue may concentrate isoflavones to potentially anti-carcinogenic levels. In addition, it is noteworthy that isoflavones may act as an agonist in PCa.
Conclusions:
Isoflavones play a protective role against the development of PCa. However, careful consideration should be given when isoflavones are used in the prevention and treatment of PCa.
Perspective
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在无症状人群中合理使用计算机断层扫描进行个体健康评估：中国经验Liang Wang, Ba-Sen Li, Wen-Zhen Zhu, Qiong Li, Xiao-Yuan Feng
中华医学杂志英文版2016年 129卷 03期
DOI: 10.4103/0366-6999.174504
摘要
计算机断层扫描（CT）自发明并用于临床或研究以来，目前广泛应用于诊断、分期、评估疾病对治疗的反应，具有更清晰的图像质量和更短的扫描时间。有许多疾病在早期不容易被发现，症状明显，不知不觉地将感染传播给他人，很容易被遗漏。当临床症状出现时，疾病可能已处于晚期，其治疗效果和预后将明显变差。CT可用于无症状人群的筛查和个体健康评估（IHA），提高疾病的检出率，实现疾病的早诊早治，从而提高患者的生存率。尽管防护措施在不断改进，但CT扫描过程中辐射的产生是不可避免的。在受检者接受的辐射剂量中，CT检查作为辐射源的比例越来越大。如何在无症状人群中合理使用CT进行IHA，降低CT的辐射剂量已成为研究热点。2014年，WHO在德国慕尼黑召开了“CT在无症状人群IHA中的合理应用”国际峰会，并达成共识。目前，欧美国家对肺癌、结直肠癌和冠心病无症状人群使用CT进行IHA的研究较多，并建立了相关策略。本文总结和分析了中国无症状人群CT的应用和相关的辐射剂量减少。
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中国公立医院治理研究：执行问题视角Yue-Han Yang
中华医学杂志英文版2016年 129卷 03期
DOI: 10.4103/0366-6999.174505
摘要
哈特曾在《公司治理：一些理论与启示》一书中提出，在委托代理关系中，如果委托人和代理人之间存在利益冲突，没有完全契约的支持，就会出现治理问题。[
Short Communication
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超声评估冈上肌腱损伤：与关节镜的相关性Li-Ping Guo, Wei-Ming Wang, Ye-Hong Wang, Yu-Peng Liu, Xiao-Bin Yu, Xiao-Jun Ma
中华医学杂志英文版2016年 129卷 03期
DOI: 10.4103/0366-6999.174486
摘要
肩袖损伤在所有运动中都很常见。在所有肩袖损伤中，冈上肌腱受累最多。严重冈上肌腱损伤可能影响患者的生活质量。然而，冈上肌腱损伤在某些情况下可能相对无症状，可能需要超声检查进行诊断。[
Clinical Experience
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子宫腺肌病不典型腺体增生转化10例临床病理特征Hong-Lan Zhu, Song-Yuan Gao, Dan-Hua Shen, Heng Cui
中华医学杂志英文版2016年 129卷 03期
DOI: 10.4103/0366-6999.174485
摘要
虽然子宫腺肌病在很大程度上是一种良性疾病，但在极少数情况下确实会发生恶变，导致子宫肌层中的子宫内膜样腺癌或肉瘤。近年来，子宫内膜异位症的恶变已成为人们关注的焦点。1988年由LaGrenade和Silverberg首次提出非典型子宫内膜异位症（aEM）的概念，[
Images for Diagnosis
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脾动脉瘤的CT血管造影诊断与治疗Chun-Xi Wang, Shu-Li Guo, Li-Na Han, Yang Jie, Hai-Di Hu, Jing-Ru Cheng, Miao Yu, Yue-Yong Xiao, Tai Yin, Fu-Tao Chu 等
中华医学杂志英文版2016年 129卷 03期
DOI: 10.4103/0366-6999.174506
摘要
脾动脉瘤，无明显症状，一旦破裂为失血性休克，直接威胁患者生命。影像学检查一直是脾动脉瘤的主要诊断方法，包括超声、计算机断层扫描（CT）、磁共振成像、数字减影血管造影（DSA）等。虽然各种检查方法各有优缺点，但腹部CT检查是临床上应用最全面的方法。本研究提供了来自相对大量患者的脾动脉瘤CT检查的代表性图像。
Correspondence
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1例成人肺部病变患者哌替啶诱发癫痫发作Wei Luo, Ya-Lun Li, Qi Yu, Yi-Shi Li, Shu-Liang Guo
中华医学杂志英文版2016年 129卷 03期
DOI: 10.4103/0366-6999.174498
摘要
致编者：哌替啶，也称为哌替啶，是最常用的阿片类镇痛药之一。哌替啶通过产生阿片受体(μ-受体)的长期激活而发挥高度的中枢神经系统抑制作用。我们描述了一例罕见的全身性强直阵挛性癫痫发作病例，患者在静脉（IV）注射哌替啶用于支气管镜术前用药后，患有肺部病变，且既往无癫痫发作史。
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胸腺瘤合并全反位Kai-Lai Yang, Jian Li
中华医学杂志英文版2016年 129卷 03期
DOI: 10.4103/0366-6999.174499
摘要
致编者：一名46岁男性入院主诉胸闷、气短、呼吸困难4天。4天前，他酒后胸痛，感觉气短、呼吸困难。休息后他感觉好多了，但症状仍然周期性地复发。盗汗、低热，最高体温37.6℃。患者否认有任何其他不适，如心悸、咳嗽、咳痰、咯血或虚弱。胸片示纵隔轻度增宽。非增强计算机断层扫描（CT）显示：倒置位，前上纵隔右侧7.5 cm × 5.3 cm软组织肿块；右肺被压迫。进行了正电子发射断层扫描-CT，结果显示患者有全反位。另见前上纵隔右侧7.4 cm × 5.2 cm × 5.3 cm软组织肿块，边缘光滑，密度不均匀。固体部分的平均CT值为40 Hounsfield单位，氟脱氧葡萄糖摄取增加，最大标准摄取值为2.6[
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位于脑凸相的表皮样囊肿，影像不典型Han-Hai Zeng, Jing-Sen Chen, Chi Gu, Gao Chen
中华医学杂志英文版2016年 129卷 03期
DOI: 10.4103/0366-6999.174495
摘要
致编者：表皮样囊肿，1807年由法国医学院的一位艺术家首次描述，[
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锂在儿童精神病学中显然没有得到充分利用Ahmed Naguy
中华医学杂志英文版2016年 129卷 03期
DOI: 10.4103/0366-6999.174502
摘要
致编辑：弗雷德里克·古德温（Frederick Goodwin）是双相情感障碍领域的一位有影响力的人物，他有一句名言：如果你不能，或者你不会使用锂，那就退出治疗双相情感障碍的行业吧！锂仍然是双相情感障碍的金标准治疗方法。但是，令人痛苦的是，尽管美国食品药品监督管理局批准了12岁及以上的儿童，但它在儿童/青少年精神病学中没有得到充分利用。近日，发现等人。[
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小儿眉毛单纯性脂肪囊肿误诊1例Karin Milleni Araujo, Rafael Denadai
中华医学杂志英文版2016年 129卷 03期
DOI: 10.4103/0366-6999.174493
摘要
致编辑：一名4岁女孩有16个月的眉毛肿胀史。儿科医生和普通外科医生诊断她患有皮脂腺囊肿，由于两次手术引流和抗生素治疗均未成功，她被转诊到我们单位。经检查，在左眉毛上发现一个柔软、可自由移动、非压痛的皮下病变[
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