MedNexus
2017年 · 第130卷第16期
出版日期 2017-08-20电子版 ￥0.00元
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Editorial
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心房颤动消融术：适应症、结果、并发症和未来方向Xue-Yuan Guo, Chang-Sheng Ma
中华医学杂志英文版2017年 130卷 16期
DOI: 10.4103/0366-6999.211900
摘要
心房颤动（AF）是最常见的心律失常类型，在全世界影响3300万人。[
Original Article
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急诊科急性心力衰竭的特征、治疗和预后：一项在北京中国队列中进行的1年随访的多中心注册研究Guo-Gan Wang, Si-Jia Wang, Jian Qin, Chun-Sheng Li, Xue-Zhong Yu, Hong Shen, Li-Pei Yang, Yan Fu, Ya-An Zheng, Bin Zhao 等
中华医学杂志英文版2017年 130卷 16期
DOI: 10.4103/0366-6999.211880
摘要
Background:
The emergency department (ED) has a pivotal influence on the management of acute heart failure (AHF), but data concerning current ED management are scarce. This Beijing AHF Registry Study investigated the characteristics, ED management, and short- and long-term clinical outcomes of AHF.
Methods:
This prospective, multicenter, observational study consecutively enrolled 3335 AHF patients who visited 14 EDs in Beijing from January 1, 2011, to September 23, 2012. Baseline data on characteristics and management were collected in the EDs. Follow-up data on death and readmissions were collected until November 31, 2013, with a response rate of 92.80%. The data were reported as median (interquartile range) for the continuous variables, or as number (percentage) for the categorical variables.
Results:
The median age of the enrolled patients was 71 (58–79) years, and 46.84% were women. In patients with AHF, coronary heart disease (43.27%) was the most common etiology, and myocardium ischemia (30.22%) was the main precipitant. Most of the patients in the ED received intravenous treatments, including diuretics (79.28%) and vasodilators (74.90%). Fewer patients in the ED received neurohormonal antagonists, and 25.94%, 31.12%, and 33.73% of patients received angiotensin converting enzyme inhibitors/angiotensin receptor blockers, beta-blockers, and spironolactone, respectively. The proportions of patients who were admitted, discharged, left against medical advice, and died were 55.53%, 33.58%, 7.08%, and 3.81%, respectively. All-cause mortalities at 30 days and 1 year were 15.30% and 32.27%, respectively.
Conclusions:
Substantial details on characteristics and ED management of AHF were investigated. The clinical outcomes of AHF patients were dismal. Thus, further investigations of ED-based therapeutic approaches for AHF are needed.
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左房内径和氨基末端脑钠肽前体与CHA2DS2-VASc评分联合预测病态窦房结综合征起搏器植入后卒中和死亡的价值Bin-Feng Mo, Qiu-Fen Lu, Shang-Biao Lu, Yu-Quan Xie, Xiang-Fei Feng, Yi-Gang Li
中华医学杂志英文版2017年 130卷 16期
DOI: 10.4103/0366-6999.211881
摘要
Background:
The CHA2DS2-VASc score is used clinically for stroke risk stratification in patients with atrial fibrillation (AF). We sought to investigate whether the CHA2DS2-VASc score predicts stroke and death in Chinese patients with sick sinus syndrome (SSS) after pacemaker implantation and to evaluate whether the predictive power of the CHA2DS2-VASc score could be improved by combining it with left atrial diameter (LAD) and amino-terminal pro-brain natriuretic peptide (NT-proBNP).
Methods:
A total of 481 consecutive patients with SSS who underwent pacemaker implantation from January 2004 to December 2014 in our department were included. The CHA2DS2-VASc scores were retrospectively calculated according to the hospital medical records before pacemaker implantation. The outcome data (stroke and death) were collected by pacemaker follow-up visits and telephonic follow-up until December 31, 2015.
Results:
During 2151 person-years of follow-up, 46 patients (9.6%) suffered stroke and 52 (10.8%) died. The CHA2DS2-VASc score showed a significant association with the development of stroke (hazard ratio [HR] 1.45, 95% confidence interval [CI] 1.20–1.75, P < 0.001) and death (HR 1.45, 95% CI 1.22–1.71, P < 0.001). The combination of increased LAD and the CHA2DS2-VASc score improved the predictive power for stroke (C-stat 0.69, 95% CI 0.61–0.77 vs. C-stat 0.66, 95% CI 0.57–0.74, P = 0.013), and the combination of increased NT-proBNP and the CHA2DS2-VASc score improved the predictive power for death (C-stat 0.70, 95% CI 0.64–0.77 vs. C-stat 0.67, 95% CI 0.60--0.75, P = 0.023).
Conclusions:
CHA2DS2-VASc score is valuable for predicting stroke and death risk in patients with SSS after pacemaker implantation. The addition of LAD and NT-proBNP to the CHA2DS2-VASc score improved its predictive power for stroke and death, respectively, in this patient cohort. Future prospective studies are warranted to validate the benefit of adding LAD and NT-proBNP to the CHA2DS2-VASc score for predicting stroke and death risk in non-AF populations.
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阿司匹林治疗心肌梗死患者的上消化道并发症和心血管/胃肠道风险计算器Lei Wen
中华医学杂志英文版2017年 130卷 16期
DOI: 10.4103/0366-6999.211889
摘要
Background:
Aspirin is widely used for the prevention of cardiovascular and cerebrovascular diseases for the past few years. However, much attention has been paid to the adverse effects associated with aspirin such as gastrointestinal bleeding. How to weigh the benefits and hazards? The current study aimed to assess the feasibility of a cardiovascular/gastrointestinal risk calculator, AsaRiskCalculator, in predicting gastrointestinal events in Chinese patients with myocardial infarction (MI), determining unique risk factor(s) for gastrointestinal events to be considered in the calculator.
Methods:
The MI patients who visited Shapingba District People’s Hospital between January 2012 and January 2016 were retrospectively reviewed. Based on gastroscopic data, the patients were divided into two groups: gastrointestinal and nongastrointestinal groups. Demographic and clinical data of the patients were then retrieved for statistical analysis. Univariate and multiple logistic regression analyses were used to identify independent risk factors for gastrointestinal events. The receiver operating characteristic (ROC) curves were used to assess the predictive value of AsaRiskCalculator for gastrointestinal events.
Results:
A total of 400 MI patients meeting the eligibility criteria were analyzed, including 94 and 306 in the gastrointestinal and nongastrointestinal groups, respectively. The data showed that age, male gender, predicted gastrointestinal events, and Helicobacter pylori (HP) infection were positively correlated with gastrointestinal events. In multiple logistic regression analysis, predicted gastrointestinal events and HP infection were identified as risk factors for actual gastrointestinal events. HP infection was highly predictive in Chinese patients; the ROC curve indicated an area under the curve of 0.822 (95% confidence interval: 0.774–0.870). The best diagnostic cutoff point of predicted gastrointestinal events was 68.0‰, yielding sensitivity and specificity of 60.6% and 93.1%, respectively, for predicting gastrointestinal events in Chinese patients with MI.
Conclusions:
AsaRiskCalculator had a predictive value for gastrointestinal events in Chinese patients with MI. HP infection seemed to be an independent risk factor for gastrointestinal events caused by long-term aspirin treatment in Chinese patients with MI, and it should be included in the risk calculator adapted for Chinese patients.
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透析对尿毒症合并冠心病患者抗血小板药物疗效的影响Dong-Liang Fu, Ting-Ting Zhao, Wen-Hua Peng, Peng Yang, Xiao-Fei Liu, Hu Zhang, Xian-Lun Li, Yong Wang, Jin-Gang Zheng, Yan-Xiang Gao 等
中华医学杂志英文版2017年 130卷 16期
DOI: 10.4103/0366-6999.211888
摘要
Background:
Coronary intervention therapy is the main treatment for uremic patients with coronary heart disease. The studies on whether dialysis reduces the efficacy of dual antiplatelet drugs are limited. The aim of this study was to examine the effect of dialysis on antiplatelet drugs in uremic patients with coronary heart disease.
Methods:
This study included 26 uremic patients who had undergone percutaneous coronary intervention in China-Japan Friendship Hospital from November 2015 to May 2017. We examined their thromboelastography results before and after hemodialysis. Self-paired t-tests were employed to analyze changes in the inhibition rate of platelet aggregation.
Results:
The mean inhibition rates of arachidonic acid-induced platelet aggregation before and after hemodialysis were 82.56 ± 2.79% and 86.42 ± 3.32%, respectively (t = −1.278, P = 0.213). The mean inhibition rates of adenosine diphosphate-induced platelet aggregation before and after hemodialysis were 67.87 ± 5.10% and 61.94 ± 5.90%, respectively (t = 1.425, P = 0.167). There was no significant difference in the inhibition rates of platelet aggregation before or after hemodialysis. These results also applied to patients with different sensitivity to aspirin and clopidogrel.
Conclusion:
Dialysis did not affect the antiplatelet effects of aspirin and clopidogrel in uremic patients with coronary heart disease.
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儿童先天性冠状动脉瘘伴巨大冠状动脉瘤的经导管封堵术：一个中心的经验Yi-Fan Li, Zhi-Wei Zhang, Shu-Shui Wang, Zhao-Feng Xie, Xu Zhang, Yu-Fen Li
中华医学杂志英文版2017年 130卷 16期
DOI: 10.4103/0366-6999.211894
摘要
Background:
Transcatheter closure of congenital coronary artery fistulas (CCAFs) is an alternative therapy to surgery; however, data regarding transcatheter closure for CCAF with a giant coronary artery aneurysm (CAA) in pediatric patients are still limited due to the rarity of the disease. We aimed to evaluate the efficacy and safety of transcatheter closure for CCAF with a giant CAA in a pediatric population at a single center.
Methods:
Medical records of pediatric patients (<18 years old) who underwent transcatheter closure of CCAF with a giant CAA between April 2007 and September 2016 at Guangdong Cardiovascular Institute (Guangdong, China) were reviewed.
Results:
Twelve patients (median age, 6.1 years; range, 1.9–11.0 years) underwent successful transcatheter closure procedures. One patient underwent closure at both the entry and exit points of the CAA, three patients underwent closure at the exit point of the CAA, and eight patients underwent closure at the entry point of the CAA. After a mean follow-up of 7.2 years (range, 0.5–9.8 years), one patient (with closure at the exit point of the CAA) underwent transcatheter re-intervention because of a significant residual shunt. She eventually underwent a surgical procedure due to aneurysm dilation after the second intervention. One patient experienced thrombus formation within the CAA after the procedure. Among those with closure at the entry point of the CAA, a mild-to-moderate residual shunt was detected in three patients.
Conclusions:
Transcatheter closure appears to be a safe and effective alternative therapy for CCAF with a giant CAA in the pediatric population. Closure at the entry point of the CAA, and closure at both the entry and exit points when feasible, may reduce the risk of postinterventional complications.
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从脑电图中提取疼痛指数定量评价疼痛Jian-Xiong An, Yong Wang, Doris K Cope, John P Williams
中华医学杂志英文版2017年 130卷 16期
DOI: 10.4103/0366-6999.211878
摘要
Background:
The current pain assessment methods are strongly subjective and easily affected by outside influences, and there is an urgent need to develop a reliable objective and quantitative pain-monitoring indicator. The aim of this study was to evaluate the feasibility of using Pain index (Pi) to assess pain symptoms in pain patients.
Methods:
Subjects were enrolled from patients seeking treatment at Pain Medicine Center of China Medical University Aviation General Hospital from October 2015 to December 2016, such as postherpetic neuralgia, spinal cord injury, femoral head necrosis, lumbar disc herniation, trigeminal neuralgia, complex regional pain syndrome, perineal pain, phantom limb pain, etc., (pain group, n = 111), as well as healthy volunteers without subjective pain (control group, n = 100). The subjective pain symptoms in pain patients were evaluated by Pi and visual analogue scale/numerical rating scales (VAS/NRS), respectively, and the relationship between them was analyzed using single factor correlation analysis and multiple factor regression analysis.
Results:
Pi levels in the pain group were significantly higher than those of the control group (t = 6.273, P < 0.001 ), the correlation analysis of Pi and VAS/NRS score in the pain group showed that the Pearson correlation coefficient was 0.797 (P < 0.001); After adjusted for types of pain, pain sites, medication, gender, and age, Pi was found to be independently correlated to VAS/NRS score (P < 0.001).
Conclusions:
Pi significantly correlates with VAS/NRS score, might be used to evaluate the subjective pain symptoms in patients and has good research and application value as an objective pain assessment tool.
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子宫内膜异位症生育指数预测子宫内膜异位症术后妊娠Xin Li, Cheng Zeng, Ying-Fang Zhou, Hui-Xia Yang, Jing Shang, Sai-Nan Zhu, Qing Xue
中华医学杂志英文版2017年 130卷 16期
DOI: 10.4103/0366-6999.211892
摘要
Background:
The endometriosis fertility index (EFI) has a predictive value for pregnancy after surgery. In vitro fertilization and embryo transfer (IVF-ET) is a good treatment to infertility. This study aimed to provide external validation of EFI, assess the factors affecting the ability of EFI to predict cumulative spontaneous pregnancy rates (PRs), and propose reasonable advice for treatment by evaluating the effect of infertility management combining surgery and IVF-ET.
Methods:
This retrospective study enrolled 345 endometriosis-related infertile women after laparoscopic surgery from January 2012 to January 2016. Among them, 234 patients tried to conceive naturally and were divided into six groups according to their different EFI scores. Of the 345 patients, 307 with an EFI score ≥5 were divided into non-IVF-ET group (n = 209) and IVE-ET group (n = 98) to compare the cumulative PRs. Cumulative PRs’ curves were calculated using the Kaplan-Meier product limit estimate and the differences were evaluated by log-rank test. Independent predictive factors for pregnancy were assessed using the Cox regression model.
Results:
Significant differences in spontaneous PRs among different EFI scores were identified (χ2 = 29.945, P < 0.05). The least function score was proved to be the most important factor for EFI (χ2 = 6.931, P < 0.05) staging system. In patients with an EFI score ≥5 after 12 months from surgery, the cumulative PRs of those who received both surgery and IVF-ET were much higher than the spontaneous PRs of those who received surgery alone (χ2 = 4.160, P = 0.041).
Conclusions:
The EFI is a reliable staging system to predict the spontaneous PR of patients. The least function score was the most influential factor to predict the spontaneous PR. Patients with an EFI score ≥5 after 12 months from surgery are recommended to receive IVF-ET to achieve a higher PR.
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经动脉栓塞治疗症状性多囊肝病2年以上随访Jin-Long Zhang, Kai Yuan, Mao-Qiang Wang, Jie-Yu Yan, Hai-Nan Xin, Yan Wang, Feng-Yong Liu, Yan-Hua Bai, Zhi-Jun Wang, Feng Duan 等
中华医学杂志英文版2017年 130卷 16期
DOI: 10.4103/0366-6999.211882
摘要
Background:
Currently, treatment of symptomatic polycystic liver disease (PLD) is still a challenging problem, especially for these patients who are not feasible for surgery. Minimally invasive options such as laparoscopic fenestration and percutaneous cyst aspiration with sclerotherapy demonstrated disappointing results due to multiple lesions. Because the cysts in PLD are mostly supplied from hepatic arteries but not from portal veins, transcatheter arterial embolization (TAE) of the hepatic artery branches that supply the major hepatic cysts can lead to shrinkage of the cyst and liver size, relieve symptoms, and improve nutritional status. This study aimed to evaluate the effectiveness of TAE with a mixture of N-butyl-2-cyanoacrylate (NBCA) and iodized oil for patients with severe symptomatic PLD during a more than 2-year follow-up.
Methods:
Institutional review board had approved this study. Written informed consent was obtained from all patients. From February 2007 to December 2014, twenty-three patients (20 women and 3 men; mean age, 49.0 ± 14.5 years) infeasible for surgical treatments underwent TAE. Changes in the abdominal circumferences, volumes of intrahepatic cysts, hepatic parenchyma volume, and whole liver, clinical symptoms, laboratory data, and complications were evaluated after TAE.
Results:
Technical success was achieved in all cases. No procedure-related major complications occurred. The median follow-up period after TAE was 48.5 months (interquartile range, 30.0–72.0 months). PLD-related severe symptoms were improved remarkably in 86% of the treated patients; TAE failed to benefit in four patients (four patients did not benefit from TAE). The mean maximum abdominal circumference decreased significantly from 106.0 ± 8.0 cm to 87.0 ± 15.0 cm (P = 0.021). The mean intrahepatic cystic volume reduction rates compared with pre-TAE were 36% at 12 months, 37% at 24 months, and 38% at 36 months after TAE (P < 0.05). The mean liver volume reduction rates were 32% at 12 months, 31% at 24 months, and 33% at 36 months (P < 0.05).
Conclusions:
TAE with the mixture of NBCA and iodized oil appears to be a safe and effective treatment method for patients with symptomatic PLD, especially for those who are not good candidates for surgical treatments, to improve both hepatic volume and hepatic cysts volume.
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基于美国癌症联合委员会的解剖和预后分期组回顾性生存分析8th人表皮生长因子受体2阴性乳腺癌肿瘤分期手册Ling Xu, Jiang-Hong Li, Jing-Ming Ye, Xue-Ning Duan, Yuan-Jia Cheng, Ling Xin, Qian Liu, Bin Zhou, Yin-Hua Liu
中华医学杂志英文版2017年 130卷 16期
DOI: 10.4103/0366-6999.211896
摘要
Background:
Current understanding of tumor biology suggests that breast cancer is a group of diseases with different intrinsic molecular subtypes. Anatomic staging system alone is insufficient to provide future outcome information. The American Joint Committee on Cancer (AJCC) expert panel updated the 8th edition of the staging manual with prognostic stage groups by incorporating biomarkers into the anatomic stage groups. In this study, we retrospectively analyzed the data from our center in China using the anatomic and prognostic staging system based on the AJCC 8th edition staging manual.
Methods:
We reviewed the data from January 2008 to December 2014 for cases with Luminal B Human Epidermal Growth Factor Receptor 2 (HER2)-negative breast cancer in our center. All cases were restaged using the AJCC 8th edition anatomic and prognostic staging system. The Kaplan-Meier method and log-rank test were used to compare the survival differences between different subgroups. SPSS software version 19.0 (IBM Corp., Armonk, NY, USA) was used for the statistical analyses.
Results:
This study consisted of 796 patients with Luminal B HER-negative breast cancer. The 5-year disease-free survival (DFS) of 769 Stage I–III patients was 89.7%, and the 5-year overall survival (OS) of all 796 patients was 91.7%. Both 5-year DFS and 5-year OS were significantly different in the different anatomic and prognostic stage groups. There were 372 cases (46.7%) assigned to a different group. The prognostic Stage II and III patients restaged from anatomic Stage III had significant differences in 5-year DFS (χ2 = 11.319, P = 0.001) and 5-year OS (χ2 = 5.225, P = 0.022). In addition, cases restaged as prognostic Stage I, II, or III from the anatomic Stage II group had statistically significant differences in 5-year DFS (χ2 = 6.510, P = 0.039) but no significant differences in 5-year OS (χ2 = 5.087, P = 0.079). However, the restaged prognostic Stage I and II cases from anatomic Stage I had no statistically significant differences in either 5-year DFS (χ2 = 0.440, P = 0.507) or 5-year OS (χ2 = 1.530, P = 0.216).
Conclusions:
The prognostic staging system proposed in the AJCC 8th edition refines the anatomic stage group in Luminal B HER2-negative breast cancer and will lead to a more personalized approach to breast cancer treatment.
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胆碱能神经支配、自噬与良性前列腺增生发病的相关性研究Jian-Liang Cai, Wei-Min Yao, Yan-Qun Na
中华医学杂志英文版2017年 130卷 16期
DOI: 10.4103/0366-6999.211877
摘要
Background:
Whether cholinergic innervations and/or autophagy have a role in the etiopathology of benign prostatic hyperplasia (BPH) is still unknown. This study aimed to investigate the role of cholinergic innervation and autophagy in the etiopathology of BPH.
Methods:
Male, 13-week-old spontaneous hypertension rats (spontaneous BPH animal model) were divided into three groups: an experimental group (EG, n = 24), a control group (CG, n = 24), and a normal control group (NC, n = 10). The EG animals were intragastrically injected with tolterodine (3.5 mg/kg, twice a day), CG animals were intragastrically injected with physiological saline, and the NC animals did not receive any treatment. Rats were sacrificed every 4 weeks, and the prostatic gross morphological changes, wet weight/body weight (ww/bw), dry weight/wet weight (dw/ww), histological changes, ultrastructural changes, and LC3 immunohistochemistry were continuously observed and compared.
Results:
The gross morphological and ww/bw changes in the three groups were similar at every stage. The dw/ww (mg/mg) values of the EG at week 17, 21, 25, and 29 were 0.1478 ± 0.0034, 0.1653 ± 0.0036, 0.1668 ± 0.0045, and 0.1755 ± 0.0034, respectively, and the CG values were 0.1511 ± 0.0029, 0.1734 ± 0.0020, 0.1837 ± 0.0052, and 0.1968 ± 0.0045, respectively. The difference between EG and CG for dw/ww showed statistical significance after 21 weeks of age (week 21: P = 0.016, week 25: P = 0.008, and week 29: P = 0.001). Both EG and CG, prostatic glandular epithelial cell proliferation, and secretory function improved with age, but in EG, these improvements were slower than those in CG, and all the differences were statistically significant after 21 weeks. An increasing number of autophagosomes in the prostatic glandular cell cytoplasm, attenuation of LC3-I immunohistochemical staining, enhancement of LC3-II staining, and the ratio of LC3-II/LC3-I staining were all progressive in both groups, but the rate of change in EG was faster than that in CG, and these differences gained statistical significance after 25 weeks. Comparisons with regard to the above indexes between CG and NC showed no statistical significance at any stage.
Conclusions:
Cholinergic innervations and activation of autophagy appear to have important functions in the etiopathology of BPH. Drug-mediated blockade of cholinergic innervations could delay the physiopathology processes. Moreover, overactivation of autophagy may also play an important role in this delay.
Review Article
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老年高血压患者的血压目标Peng Liu, Jin-Gang Zheng
中华医学杂志英文版2017年 130卷 16期
DOI: 10.4103/0366-6999.211885
摘要
Objective:
Hypertension is an important risk factor of cardiovascular disease and increases mortality in the elderly. However, the available medical evidences are both inconsistent and insufficient regarding establishing credible and useful blood pressure (BP) targets in the hypertensive elderly. This review summarizes the existing evidences used for establishing optimal BP targets for this patient population and points out some data inconsistencies which have added to the uncertainty.
Data Sources:
We conducted a search for the articles published in English in the PubMed database up to March 2017, with the keywords "hypertension," "elderly," "blood pressure," and "antihypertensive."
Study Selection:
Articles that related to BP targeting in the hypertensive elderly were selected for this review.
Results:
The selected studies indicated that antihypertensive therapy can substantially reduce the risk of cardiovascular events and mortality, for a subset of the elderly (60 years or older) with systolic BP >160 mmHg. Studies regarding more strict targets yielded mixed findings. For the very old and frail patients (80 years or older), there is a lack of evidence that optimal BP targets and intensive antihypertensives are helpful but in fact may be harmful.
Conclusions:
There are solid evidences that patients who are 60–80 years old and in good health have benefited from lowering their BP to below 150/90 mmHg. If well tolerated, the BP target can be further lowered to below 140/90 mmHg. However, for the very old and frail, individualized and careful assessment is crucial. Antihypertensive treatment should be cautious and the adverse effect of drugs requires close monitoring as such treatment can be counterproductive.
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原发性中枢神经系统淋巴瘤的病理生物学研究进展Xue-Liang Yang, Yuan-Bo Liu
中华医学杂志英文版2017年 130卷 16期
DOI: 10.4103/0366-6999.211879
摘要
Objective:
Primary central nervous system lymphoma (PCNSL) is a specific type of non-Hodgkin lymphoma with poor prognosis. The rare incidence of this disease and difficulty to obtain sufficient tissue material impede deep research into PCNSL. However, application of modern molecular techniques makes it possible to find biological characteristics exclusive to PCNSL. Therefore, we systematically reviewed the latest research progress on biological characteristics and pathogenesis of PCNSL.
Data Sources:
The data analyzed in this review were from the articles listed in PubMed database.
Study Selection:
Articles focusing on the biology of PCNSL at the cytogenetic or molecular level were reviewed, including clinical, basic research, and review articles.
Results:
With respect to histopathology, perivascular growth pattern and reactive perivascular T-cell infiltration are regarded as typical histopathological manifestations of tumor cells in PCNSL. Moreover, tumor cells of PCNSL predominantly express an activated B-cell-like phenotype, including CD10− BCL-6+ MUM1+, CD10− BCL-6− MUM1+, and CD10− BCL-6− MUM1−. On the molecular level, some molecular and genetic alterations may contribute to malignant transformation, including mutations of proto-oncogenes and tumor suppressor genes, gains and losses of genetic material, as well as aberrant activation of some important signaling pathways, such as nuclear factor-κB and JAK/STAT pathway.
Conclusions:
The integrated molecular mechanisms involved in pathogenesis of PCNSL are not well understood. The important biomarkers indicating prognosis are not identified. Multicenter studies should be carried out to elucidate pathogenesis of PCNSL to find novel and effective therapeutic strategies.
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同型半胱氨酸：银屑病心血管风险和DNA甲基化的潜在共同途径Wen-Ming Wang, Hong-Zhong Jin
中华医学杂志英文版2017年 130卷 16期
DOI: 10.4103/0366-6999.211895
摘要
Objective:
Homocysteine is a sulfur-containing amino acid with potential clinical significance. Abnormal homocysteine levels have been found in patients with psoriasis. This review summarizes the possible correlations among homocysteine, cardiovascular risk, and DNA methylation in psoriasis.
Data Sources:
We retrieved the articles published in English from the PubMed database up to January 2017, using the keywords including "psoriasis," "homocysteine," "cardiovascular risk," "DNA methylation," "methylenetetrahydrofolate reductase," "MTHFR," and "MTHFR C677T."
Study Selection:
Articles about the roles of homocysteine in the cardiovascular risk and DNA methylation in psoriasis were obtained and reviewed.
Results:
Observational studies consistently reported that elevated homocysteine is an independent risk factor for cardiovascular diseases. Several studies also consistently reported an association between psoriasis and increased cardiovascular risk. A substantial body of evidence also suggested that an elevated homocysteine level is related to the demethylation of DNA. Data from clinical trials also demonstrated that MTHFR C677T polymorphisms as well as DNA methylation aberrations are associated with psoriasis.
Conclusions:
This review highlighted the relationships among homocysteine, cardiovascular risk, and DNA methylation, suggesting that homocysteine may be a biological link between cardiovascular risk and DNA methylation in psoriasis.
Perspective
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锁孔显微神经外科在我国的应用Li-Gang Chen, Shu-Da Chen, Guang-Fu Huang, Ying Huang, De-Zhi Kang, Qing Lan, Gang Li, Xin-Gang Li, Zhi-Xiong Liu, Song-Tao Qi 等
中华医学杂志英文版2017年 130卷 16期
DOI: 10.4103/0366-6999.211884
摘要
显微神经外科在20世纪60年代初首次亮相。它在医学领域变得流行，并成为神经外科的主要手术方法，因为它提高了神经外科的疗效，减少了手术相关的损伤。在过去的五十年里，显微外科经验的积累、显微外科技术的改进、精细的显微器械和先进的术前诊断成像使显微神经外科技术得以发展，并进一步减少了手术相关的创伤。先进的发展使得神经外科医生能够用更小的开颅手术治疗更复杂的病变。锁孔神经外科是现代显微外科技术、术前影像学、神经内镜和现代微创手术理念的结合，是代表医学从显微神经外科向微创神经外科发展的技术之一。
Clinical Challenge
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甲状旁腺全切除自体移植后透析的继发性甲状旁腺功能亢进患者发生甲状腺毒症Zhou Xu, Yu-Tuan Wu, Xin Li, He Wu, Hao-Ran Chen, Yan-Ling Shi, Bilal Arshad, Hong-Yuan Li, Kai-Nan Wu, Ling-Quan Kong
中华医学杂志英文版2017年 130卷 16期
DOI: 10.4103/0366-6999.211886
摘要
继发性甲状旁腺功能亢进（SHPT）是慢性肾脏病（CKD）的常见并发症，其特征是甲状旁腺激素（PTH）的过度合成和甲状旁腺增生。[
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右美托咪定和七氟醚麻醉诱导治疗小儿困难气道Ling-Xin Wei, Xiao-Ming Deng, Jing-Hu Sui, Lei Wang
中华医学杂志英文版2017年 130卷 16期
DOI: 10.4103/0366-6999.211883
摘要
困难气道是麻醉师经常面临的挑战。对于颈部和胸壁有严重瘢痕挛缩的烧伤恢复期患儿，最佳策略是在麻醉诱导期间保持自主呼吸，尽早插入喉罩气道以确保气道安全。
Clinical Picture
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经颈静脉肝内门体分流术治疗难治性肝性胸水合并门静脉血栓形成Lin-Hao Zhang, Huan Tong, Bo Wei, Hao Wu, Cheng-Wei Tang
中华医学杂志英文版2017年 130卷 16期
DOI: 10.4103/0366-6999.211887
摘要
4-12%的肝硬化患者发生肝性胸水。[
Correspondence
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胰腺炎合并EB病毒诱导的传染性单核细胞增多症Zhen Zhu, Shao-Jun Yin, Zhi-Bin Kong, Hong Li, Liu-Ping Hu, Shen Zuo, Yi Liu, Shuang Song, Hua Liu, Amber Lee
中华医学杂志英文版2017年 130卷 16期
DOI: 10.4103/0366-6999.211875
摘要
致编者：35岁女性，发热、咽痛6天病史入院。入院时发热，直肠体温40.2℃。她的脉搏正常，为90次/分钟，血压为93/69毫米汞柱。其他发现包括呕吐、腹痛和上躯干黄斑皮疹。她在右上腹和上腹部也有腹部压痛，没有防护。
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随访运动心电图可以确认运动性心肌缺血和冠状动脉血管痉挛引起的危及生命的心律失常的治疗是否适当Ming-Jui Hung, Yu-Cheng Kao
中华医学杂志英文版2017年 130卷 16期
DOI: 10.4103/0366-6999.211891
摘要
致编者：运动性ST段抬高是一种不常见的临床情况，患病率为0.15%。[
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阵发性心房颤动伴持续性左上腔静脉伴右上腔静脉缺失患者的起搏器植入Tao Zhang, Jun Wang, Tan Ming, Li-Hua Shang
中华医学杂志英文版2017年 130卷 16期
DOI: 10.4103/0366-6999.211898
摘要
致编者：持续性左上腔静脉(PLSVC)伴右上腔静脉(RSVC)缺失是一种非常罕见的先天性异常，可使永久性起搏器导线的植入复杂化。如果心房电极导线在房颤（AF）期间放置在右心耳之外，评估电极导线是否足够固定可能具有挑战性。我们报告了一例无RSVC和病态窦房结综合征伴阵发性房颤的PLSVC病例，其中成功植入了永久性起搏器。
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子宫内膜卵黄囊肿瘤伴大网膜转移Jin-Ke Li, Kai-Xuan Yang, Ying Zheng
中华医学杂志英文版2017年 130卷 16期
DOI: 10.4103/0366-6999.211893
摘要
致编者：一名38岁女性因月经过多持续2个月来我院就诊。双手检查未发现症状，阴道超声显示子宫内膜厚度4 mm。诊断性刮宫强烈提示透明细胞腺癌。骨盆磁共振成像显示完整的子宫内膜结合区，无子宫外浸润。其他实验室检查正常；入院时未测定血清甲胎蛋白（AFP）水平。腹腔镜探查术在全身麻醉下进行。根治性手术包括全子宫切除术、双侧输卵管卵巢切除术、盆腔和腹主动脉淋巴结切除术以及大网膜切除术。对所有手术标本进行了仔细分析。子宫后腔左角发现一个2.5 cm × 1.5 cm × 1.5 cm的肿瘤[
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1例中国成人果糖1, 6-二磷酸酶缺乏症患者Jing-Ru Lu, Cui Wang, Le-Ping Shao
中华医学杂志英文版2017年 130卷 16期
DOI: 10.4103/0366-6999.211890
摘要
编者按：果糖1, 6-二磷酸酶（FBPase）缺乏症是一种常染色体隐性代谢性疾病，其特征是由长期禁食或发热或大量摄入果糖引发的低血糖、酮症和乳酸酸中毒的发作。[
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酒精滥用致散发性迟发性皮肤卟啉症Xiu-Min Yang, Yang Zhang, Tao Wang, Yue-Hua Liu
中华医学杂志英文版2017年 130卷 16期
DOI: 10.4103/0366-6999.211897
摘要
致编者：一名50岁男性在日晒区域反复发作大疱、糜烂和结痂1年。病变愈合，伴有瘢痕和色素沉着过度。日晒后皮损加重。患者有30年的酒精滥用（100-200毫升/天）史。家族遗传史并不显著。体格检查发现面部、颈部和手背多处糜烂，伴有红斑、色素沉着过度、大疱和结痂[
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D-青霉胺诱导的穿孔弹性增生症Xue-Yan Yao, Guang-Dong Wen, Cheng Zhou, Bo-Yang Liu, Juan Du, Zhou Chen, Jian-Zhong Zhang
中华医学杂志英文版2017年 130卷 16期
DOI: 10.4103/0366-6999.211899
摘要
致编者：穿孔性弹性增生症(EPS)是不同类型穿孔性疾病的一部分，取决于特发性、反应性或药物诱导性等因素。我们在此报告一例患者，其表现为多个红棕色角质化丘疹在颈部前部和后部合并形成丝状斑块，被发现是典型的D-青霉胺诱导的EPS。
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乳腺癌化疗患者丙型肝炎病毒再激活的新型抗病毒治疗Yu-Tuan Wu, Zhou Xu, Hao-Ran Chen, Bilal Arshad, Hong-Yuan Li, Kai-Nan Wu, Ling-Quan Kong
中华医学杂志英文版2017年 130卷 16期
DOI: 10.4103/0366-6999.211876
摘要
致编者：病毒性肝炎是全球主要的公共卫生问题，据报道，全球有20亿人感染的乙型肝炎病毒（HBV）在恶性肿瘤化疗期间会重新激活。[
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