MedNexus
2017年 · 第130卷第22期
出版日期 2017-11-20电子版 ￥0.00元
MedNexus
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Editorial
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亚洲炎症性肠病管理中有哪些未回答的问题和未满足的需求？Li Yue, Qian Jia-Ming
中华医学杂志英文版2017年 130卷 22期
DOI: 10.4103/0366-6999.218018
摘要
自19世纪中期首次描述溃疡性结肠炎（UC）以来已有100多年的历史，[
Original Article
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上海评分：中国肝癌根治性切除后预后和辅助治疗评估系统的构建Sun Hui-Chuan, Xie Lu, Yang Xin-Rong, Li Wei, Yu Jian, Zhu Xiao-Dong, Xia Yong, Zhang Ti, Xu Yang, Hu Bo 等
中华医学杂志英文版2017年 130卷 22期
DOI: 10.4103/0366-6999.218019
摘要
Background:
For Chinese patients with hepatocellular carcinoma (HCC), surgical resection is the most important treatment to achieve long-term survival for patients with an early-stage tumor, and yet the prognosis after surgery is diverse. We aimed to construct a scoring system (Shanghai Score) for individualized prognosis estimation and adjuvant treatment evaluation.
Methods:
A multivariate Cox proportional hazards model was constructed based on 4166 HCC patients undergoing resection during 2001–2008 at Zhongshan Hospital. Age, hepatitis B surface antigen, hepatitis B e antigen, partial thromboplastin time, total bilirubin, alkaline phosphatase, γ-glutamyltransferase, α-fetoprotein, tumor size, cirrhosis, vascular invasion, differentiation, encapsulation, and tumor number were finally retained by a backward step-down selection process with the Akaike information criterion. The Harrell’s concordance index (C-index) was used to measure model performance. Shanghai Score is calculated by summing the products of the 14 variable values times each variable’s corresponding regression coefficient. Totally 1978 patients from Zhongshan Hospital undergoing resection during 2009–2012, 808 patients from Eastern Hepatobiliary Surgery Hospital during 2008–2010, and 244 patients from Tianjin Medical University Cancer Hospital during 2010–2011 were enrolled as external validation cohorts. Shanghai Score was also implied in evaluating adjuvant treatment choices based on propensity score matching analysis.
Results:
Shanghai Score showed good calibration and discrimination in postsurgical HCC patients . The bootstrap-corrected C-index (confidence interval [CI]) was 0.74 for overall survival (OS) and 0.68 for recurrence-free survival (RFS) in derivation cohort (4166 patients), and in the three independent validation cohorts, the CIs for OS ranged 0.70–0.72 and that for RFS ranged 0.63–0.68. Furthermore, Shanghai Score provided evaluation for adjuvant treatment choices (transcatheter arterial chemoembolization or interferon-α). The identified subset of patients at low risk could be ideal candidates for curative surgery, and subsets of patients at moderate or high risk could be recommended with possible adjuvant therapies after surgery. Finally, a web server with individualized outcome prediction and treatment recommendation was constructed.
Conclusions:
Based on the largest cohort up to date, we established Shanghai Score – an individualized outcome prediction system specifically designed for Chinese HCC patients after surgery. The Shanghai Score web server provides an easily accessible tool to stratify the prognosis of patients undergoing liver resection for HCC.
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腹腔镜子宫肌瘤切除术患者中子宫恶性肿瘤的比例：一项中国全国性多中心研究Yang Hua, Li Xiao-Chuan, Yao Chen, Lang Jing-He, Jin Hang-Mei, Xi Ming-Rong, Wang Gang, Wang Lu-Wen, Hao Min, Ding Yan 等
中华医学杂志英文版2017年 130卷 22期
DOI: 10.4103/0366-6999.218008
摘要
Background:
The Food and Drug Administration recently announced that the use of morcellation may cause fibroids or pelvic dissemination and metastasis of uterine sarcoma; therefore, the use of morcellation is limited in the USA. A large sample study is necessary to assess the proportion of uterine malignant tumors found in patients with laparoscopic myomectomy.
Methods:
A national multicenter study was performed in China. From 2002 to 2014, 33,723 cases were retrospectively selected. We calculated the prevalence and recorded the clinical characteristics of the patients with malignancy after morcellation application. A total of 62 cases were finally pathologically confirmed as malignant postoperatively. Additionally, the medical records of the 62 patients were analyzed in details.
Results:
The proportion of postoperative malignancy after morcellation application was 0.18% (62/33,723) for patients who underwent laparoscopic myomectomy. Nearly 62.9% (39/62) of patients had demonstrated blood flow signals in the uterine fibroids before surgery. And, 23 (37.1%) patients showed rapid growth at the final preoperative ultrasound. With respect to the pathological types, 38 (61.3%) patients had detectable endometrial stromal sarcoma, 13 (21.0%) had detectable uterine leiomyosarcoma, only 3 (3.2%) had detectable carcinosarcoma, and 5 (8.1%) patients with leiomyoma had an undetermined malignant potential.
Conclusions:
The proportion of malignancy is low after using morcellation in patients who undergo laparoscopic myomectomy. Patients with fast-growing uterine fibroids and abnormal ultrasonic tumor blood flow should be considered for malignant potential, and morcellation should be avoided.
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肝动脉化疗栓塞联合CT引导下射频消融治疗大肝癌Zuo Tai-Yang, Liu Feng-Yong, Wang Mao-Qiang, Chen Xian-Xian
中华医学杂志英文版2017年 130卷 22期
DOI: 10.4103/0366-6999.218002
摘要
Background:
Currently, the treatment of large hepatocellular carcinoma (HCC) is still a challenging problem. Transcatheter arterial chemoembolization (TACE) is the main treatment for intermediate end-stage HCC, while it is only a palliative and not a curative treatment due to the existence of residual tumors, and radiofrequency ablation (RFA) has limitations in complete ablation of large HCC. We hypothesized that TACE combined with simultaneous RFA (herein referred to as TACE + RFA) could improve the efficacy and survival of large HCC. This study aimed to investigate the feasibility, efficacy, and safety of TACE + RFA on single large HCC.
Methods:
A total of 66 patients with single large HCC (≥5 cm in diameter) were recruited between February 2010 and June 2016. TACE was first performed and computed tomography was performed immediately after TACE, and the lesions with poor lipiodol deposition were subjected to simultaneous RFA. The success rate, technique-related complications, liver and kidney functions, serum alpha-fetoprotein (AFP) levels, progression-free survival (PFS), median survival time (MST), focal control rate, and long-term survival rate were evaluated.
Results:
TACE + RFA were performed smoothly in all the patients with the success rate of 100%. Intra- and post-operative severe complications were not observed. There were no marked differences in mean alanine transaminase or aspartate transaminase before TACE + RFA compared with 7 days after TACE+ RFA (all P > 0.05). In 57 AFP-positive patients, the levels of serum AFP were reduced by 100.0%, 100.0%, and 94.7% at 1, 3, and 6 months after TACE + RFA, respectively; the tumor control rates (complete remission+ partial remission) were 100.0% (66/66), 92.4% (61/66), 87.9% (58/66), and 70.1% (39/55) at 1, 3, 6, and 12 months after TACE + RFA, respectively. Patients were followed up for 7–82 months after TACE + RFA. The MST was 18.3 months, PFS was 14.2 ± 6.2 months, and the 1-, 3-, and 5-year survival rates were 93.2% (55/59), 42.5% (17/40), and 27.2% (9/33), respectively.
Conclusion:
TACE + RFA is safe, feasible, and effective in enhancing the focal control rate and survival rate of patients with large HCC.
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炎症性肠病并发坏疽性脓皮病与特发性坏疽性脓皮病的临床特点比较Jiang Yan-Yun, Li Ji, Li Yue, Wang Qiang, Liu Shuang, Fang Kai, Qian Jia-Ming, Jin Hong-Zhong
中华医学杂志英文版2017年 130卷 22期
DOI: 10.4103/0366-6999.218004
摘要
Background:
Pyoderma gangrenosum (PG) is a rare neutrophilic dermatosis that is highly associated with inflammatory bowel disease (IBD). Certain PG patients with no systemic disorders have been diagnosed with idiopathic PG. This study sought to clarify the difference between PG with IBD and idiopathic PG based on clinical features, laboratory tests, and medications.
Methods:
Twelve patients with PG and IBD and 24 patients with idiopathic PG, who were hospitalized in Peking Union Medical College Hospital from 2000 to 2017, were retrospectively categorized into the IBD group and control group, respectively. Data of clinical features, laboratory tests, and medications were collected and compared between the two groups.
Results:
Both groups were similar with respect to their clinical features. However, the IBD group had an increased occurrence of arthralgia or arthritis (58.3% vs. 12.5%, P = 0.007), anemia (83.3% and 29.2%, P = 0.004), and an increased percentage of antineutrophilic cytoplasmic antibody (ANCA)-positive patients (85.7% and 0.0%, P < 0.001), compared to the control group.
Conclusion:
PG patients with IBD had increased occurrence rates of arthralgia or arthritis, anemia, and ANCA-positive status compared to idiopathic PG patients.
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之间的关系分析幽门螺杆菌感染与糖尿病胃轻瘫Huang Ju
中华医学杂志英文版2017年 130卷 22期
DOI: 10.4103/0366-6999.218012
摘要
Background:
Whether Helicobacter pylori infection is associated with diabetic gastroparesis (DGP) is unclear. This study aimed to investigate the potential correlation between H. pylori infection and DGP.
Methods:
In this study, 163 patients with type 2 diabetes mellitus and 175 nondiabetic patients who were treated in our department were divided into DGP, simple diabetes, non-DGP (NDG), and normal groups based on their conditions. The H. pylori infection rate in each group was calculated. H. pylori eradication therapy was performed for patients with H. pylori infection in each group. The eradication rates were compared between the groups, and the improvements in gastroparesis-associated symptoms were compared before and after treatment in patients with DGP.
Results:
The H. pylori infection rate was 74.6% in the DGP group, which was significantly higher than that in the simple diabetes (51.1%, P < 0.01), NDG (57.7%, P < 0.05), and normal groups (48.0%, P < 0.01). With increased disease course, the incidence of DGP and the H. pylori infection rate gradually increased (P < 0.05). In the DGP group, the incidences of upper abdominal pain and distention, early satiety, and anorexia were 75.5%, 66.0%, and 67.9%, respectively, before eradication treatment; and 43.4%, 35.8%, and 39.6%, respectively, after eradication treatment, and the difference was statistically significant (P < 0.01). In patients with DGP with successful H. pylori eradication, the number of barium strips discharged after eradication was 5.9 ± 1.0, which was significantly larger than that before treatment (4.1 ± 0.7, P < 0.01). In addition, the number of barium strips discharged was significantly larger in patients with DGP with successful H. pylori eradication than those with failed H. pylori eradication (P < 0.01).
Conclusions:
DGP development might be associated with H. pylori infection. H. pylori eradication can effectively improve dyspepsia-associated symptoms and delayed gastric emptying in patients with DGP.
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信号转导子和转录激活子3在肝细胞癌与肝硬化鉴别中的作用Li Yan-Ping, Wang Wen-Ze, Chen Xue-Qi, Li Ling-Bo, Liang Zhi-Yong, Ru Kun, Li Jing-Nan
中华医学杂志英文版2017年 130卷 22期
DOI: 10.4103/0366-6999.218016
摘要
Background:
Overexpression and constitutive activation of signal transducer and activator of transcription (STAT) 3 have been suggested in the tumorigenesis of many human cancers, including multiple carcinomas, melanoma, and lymphoma. The diagnosis of hepatocellular carcinoma (HCC) in lobectomy specimens is usually straightforward, but distinguishing cirrhosis from well-differentiated HCC can be challenging in core biopsies. Our aims were to investigate the expression level of STAT3 and phosphorylated STAT3 (pSTAT3) in HCC and cirrhosis, and the application of STAT3 in the differential diagnosis of HCC and cirrhosis.
Methods:
Sixty cases were divided into three groups: patients with HCC only (Group 1), HCC and cirrhosis (Group 2), and cirrhosis only (Group 3). Formalin-fixed and paraffin-embedded tissue sections were stained immunohistochemically for STAT3, pSTAT3, and CD163. The values obtained from the tissue sections of each group were compared in statistical analysis.
Results:
STAT3 showed a high level in HCC and was a significant marker for differentiating HCC from cirrhosis (P < 0.0001). The odds ratio between HCC and cirrhosis increased 34.4 times when the intensity of STAT3 increased by 1 level. Spearman’s correlation and Chi-square tests also demonstrated that expression level of STAT3 did not correlate with age, gender, or the presence of a cirrhotic background.
Conclusions:
STAT3 staining differs significantly in HCC and cirrhosis. The findings reinforce the role of STAT3 in the tumorigenesis of HCC and provide a useful marker to differentiate HCC from cirrhosis in challenging liver biopsies.
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结直肠癌手术中髓系细胞表达的可溶性触发受体-1与炎症标志物：一项前瞻性队列研究Đerek Lovorka, Servis Dražen, Unić Adriana
中华医学杂志英文版2017年 130卷 22期
DOI: 10.4103/0366-6999.218022
摘要
Background:
Major abdominal surgery, including colorectal cancer (CRC) surgery, leads to systemic inflammatory response syndrome that can be detected and monitored with inflammatory markers testing. The aims of the study were to evaluate the usefulness of soluble triggering receptor expressed on myeloid cells-1 (sTREM-1), interleukin-6 (IL-6), procalcitonin (PCT), and C-reactive protein (CRP) in following the inflammatory response in CRC surgery and postoperative period, as well as to determine if duration of the surgery and the time that the colon has been opened during the surgery (open colon time [OCT]) reflect a larger surgical stress through inflammatory markers rise.
Methods:
The study included 20 patients who underwent CRC surgery and 19 healthy volunteers from June 2011 to September 2012. We determined inflammatory markers 1 day before surgery (T0), 24 h (T1), 48 h (T2), and 7 days after the surgery (T3). All statistical analyses were calculated using MedCalc Statistical Software version 14.8.1 (MedCalc Software bvba, Ostend, Belgium).
Results:
Concentrations of CRP, PCT, and IL-6 in all measurement times were statistically different and sTREM-1 did not yield statistical significance. A weak positive correlation was found between IL-6 in T1 and T2 with the duration of the surgery (T1: r = 0.4060, P < 0.0001; T2: r = 0.3430, P < 0.0001) and OCT (T1: r = 0.3640, P < 0.0001, T2: r = 0.3430, P < 0.0001). A weak positive correlation between CRP in T2 and OCT (r = 0.4210, P < 0.0001) was also found. The interconnectivity of tested parameters showed a weak positive correlation between CRP and IL-6 in T1 (r= 0.3680; P < 0.0001), moderate positive correlation in T2 (r = 0.6770; P < 0.0001), and a strong positive correlation in T3 (r = 0.8651; P < 0.0001).
Conclusions:
CRP, IL-6, and PCT were shown to be reliable for postoperative monitoring. Simultaneous determination of CRP and IL-6 might not be useful as they follow similar kinetics. sTREM-1 might not be useful in CRC postoperative monitoring.
Trial Registration:
www.ClinicalTrials.gov, NCT01244022;https://www.clinicaltrials.gov/ct2/show/NCT01244022?term=01244022&rank=1.
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初治慢性乙型肝炎病毒感染患者血清乙型肝炎表面抗原和乙型肝炎e抗原水平与肝脏炎症严重程度负相关Zhang Lu, Li Ming-Hui, Cao Wei-Hua, Qi Tian-Lin, Lu Yao, Wu Shu-Ling, Hao Hong-Xiao, Shen Ge, Liu Ru-Yu, Hu Lei-Ping 等
中华医学杂志英文版2017年 130卷 22期
DOI: 10.4103/0366-6999.218000
摘要
Background:
Estimating the grades of liver inflammation is critical in the determination of antiviral therapy in patients chronically infected with hepatitis B virus (HBV). The aim of this study was to investigate the correlation of serum levels of hepatitis B surface antigen (HBsAg) and hepatitis B e antigen (HBeAg) with the liver inflammation grades in treatment-naïve patients with chronic HBV infection.
Methods:
We retrospectively enrolled 584 treatment-naïve HBeAg-positive patients who underwent liver biopsy in Ditan Hospital from January 2008 to January 2016. Based on the severity of liver inflammation, the patients were divided into minimal, mild, and moderate groups. SPSS software was used for statistical analysis of all relevant data.
Results:
The liver histological examinations showed that 324, 194, and 66 patients had minimal, mild, and moderate liver inflammation, respectively. The median age of the three groups was 30, 33, and 38 years, respectively (χ2 = 26.00, P < 0.001). The median HBsAg levels in minimal, mild, and moderate inflammation groups were 4.40, 4.16, and 3.67 log U/ml, respectively, and the median HBeAg levels in the three groups were 3.12, 2.99, and 1.86 log sample/cutoff, respectively; both antigens tended to decrease as the grade of inflammation increased (χ2 = 99.68 and χ2 = 99.23, respectively; both P < 0.001). The cutoff values of receiver operating characteristic curve in the age, HBsAg and HBeAg levels were 36 years, 4.31 log U/ml, and 2.86 log S/CO, respectively, 1 to distinguish minimal grade and other grades of treatment-naïve HBeAg-positive patients with chronic HBV infection.
Conclusions:
Serum HBsAg and HBeAg quantitation might gradually decrease with aggravated liver inflammation and the corresponding cutoff values might help us to distinguish minimal grades and other grades and detect those who do not need antiviral therapy in treatment-naïve HBeAg-positive patients with chronic HBV infection.
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晕痣患者发生白癜风的相关因素Zhou Hui, Wu Liang-Cai, Chen Mu-Kai, Liao Qi-Man, Mao Ren-Xiang, Han Jian-De
中华医学杂志英文版2017年 130卷 22期
DOI: 10.4103/0366-6999.218011
摘要
Background:
Halo nevus (HN) has been shown to be associated with vitiligo, but no standard signs are currently available to identify HN patients at risk of vitiligo, and the relevant data obtained in previous studies are somewhat conflicting. This study aimed to identify factors affecting the presence of vitiligo in HN patients.
Methods:
We performed a retrospective study on consecutive patients with HN at the First Affiliated Hospital of Sun Yat-sen University between January 2011 and December 2016. Detailed demographic and clinical data were collected to identify the factors associated with the presence of vitiligo in this cohort of patients using uni- and multi-variate logistic regression analyses.
Results:
A total of 212 HN patients were included, 101 of whom had vitiligo-associated HN (HNV). Univariate analysis indicated that a personal history of thyroid diseases was positively associated with HNV (odds ratio [OR] = 10.761, P = 0.025), while the onset age of HN was negatively associated with HNV (OR = 0.537, P = 0.026). Multivariate analysis demonstrated that the Koebner phenomenon (KP; OR = 10.632, P < 0.0001), multiple HN (OR = 3.918, P < 0.0001), and a familial history of vitiligo (OR = 3.222, P = 0.014) were independent factors associated with HNV.
Conclusions:
HN without vitiligo has clinical features distinct from HN associated with vitiligo. HN patients with KP, multiple lesions, or familial history of vitiligo are more likely to develop vitiligo and therefore should be monitored for clinical signs of such accompanied conditions.
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基因扫描研究RPE65中国Leber先天性黑蒙患者Liu Jing, Bu Juan
中华医学杂志英文版2017年 130卷 22期
DOI: 10.4103/0366-6999.218007
摘要
Background:
Leber congenital amaurosis (LCA) is a visual disease which is caused by RPE65 mutations and results in retinal degeneration and severe vision loss in early infancy. According to previous researches, mutations of the RPE65 gene account for 16% of all cases of LCA. This study aimed to identify RPE65 gene mutations in Chinese patients with LCA.
Methods:
We recruited 52 sporadic patients from Peking University Third Hospital in 2016 and applied Sanger sequencing to identify variants among exons responsible for the disease. The genomic DNAs from blood leukocytes of these patients were isolated, and the entire coding region of the RPE65 gene was amplified by polymerase chain reaction. We then determined the sequence of RPE65 using ABI 3100 Genetic Analyzer.
Results:
Our study identified that only 1 out of the 52 patients with LCA carried the previously unreported homozygosis missense mutation c1174A>C (T392P) of the RPE65 gene. However, the mutation was associated with the disease phenotype and not detected in 100 normal controls.
Conclusions:
Though we identified a novel missense mutation in the RPE65 gene that causes LCA, our result indicates that RPE65 mutations may not play a major role in the LCA patients in China since only 1 out of the 52 patients carried mutation in the RPE65 gene.
Review Article
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Hippo信号在子宫内膜纤维化中的高级作用：对宫腔粘连的意义Zhu Hai-Yan, Ge Tian-Xiang, Pan Yi-Bin, Zhang Song-Ying
中华医学杂志英文版2017年 130卷 22期
DOI: 10.4103/0366-6999.218013
摘要
Objective:
Intrauterine adhesion (IUA) is a major health problem that causes infertility, menstrual irregularities, and recurrent pregnancy losses in women. Unfortunately, treatments for IUA are limited, and there are currently no effective strategies for preventing IUA recurrence. In this review, we introduced the role of Hippo signaling in the normal endometrium and IUA and described the mechanisms by which the Hippo pathway integrates with the Wnt and transforming growth factor-β (TGF-β) signaling pathways to form an intricate network governing the development of fibrosis.
Data Sources:
Original research articles in English that were published until July 2017 were collected from the PubMed database.
Study Selection:
Literature search was conducted using the search terms "endometrial fibrosis OR fibrosis AND or OR intrauterine adhesion OR Asherman syndrome OR IUA," "Hippo AND or OR Hippo/TAZ," "TGF-β," and "Wnt." Related original research articles were included in the comprehensive analysis.
Results:
Endometrial fibrosis is recognized as a key pathological event in the development of IUA, which is characterized by epithelial/fibroblast–myofibroblast transition. Myofibroblasts play crucial roles in the pathogenesis of fibrous scarring, and myofibroblast differentiation can be triggered by multiple signaling pathways. Hippo signaling is a critical regulator of the epithelial/fibroblast–myofibroblast transition and α-smooth muscle actin, which exhibits a specific spatiotemporal expression in the endometrium.
Conclusions:
Hippo signaling plays a critical role in fibrous diseases and participates in cross talks with Wnt and TGF-β signaling. Our findings not only contributed to knowledge on the pathogenesis of endometrial fibrosis, but can also serve as a useful resource for developing specific molecular inhibitors for IUA treatment and prevention.
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中国老年麻醉相关发病率和死亡率：现状和趋势Liu Yang, Xiao Wei, Meng Ling-Zhong, Wang Tian-Long
中华医学杂志英文版2017年 130卷 22期
DOI: 10.4103/0366-6999.218006
摘要
Objective:
The population of elderly patients and the amount of geriatric anesthesia have been growing rapidly in China. Thus, understanding the morbidity and mortality associated with geriatric anesthesia in China is critical to the improvement of anesthesia quality and outcome. The aim of the review was to discuss the geriatric anesthesia-related morbidity and mortality in China, as well as to point out the future trend.
Data Sources:
Articles in this review were all searched from Wanfang, China National Knowledge Infrastructure (CNKI), VIP, PubMed, and Web of Science databases, based on the reports originated in China from January 2011 to December 2016.
Study Selection:
A total of 57 studies were selected for further study, including 12 retrospective studies, 35 prospective studies, 3 meta-analyses, 4 reviews, 1 viewpoint, and 2 case reports. Of the total studies, 42 studies were in Chinese while 15 were in English.
Results:
The mortality and morbidity associated with geriatric anesthesia in China are not yet completely reported. Some factors have been recognized, while some are yet to be identified and confirmed. Several studies addressed postoperative cognitive dysfunction and postoperative delirium, whereas only a few studies can be found on renal complications. Thus, a nationwide registry is essential for geriatric anesthesia-associated adverse outcomes. The mortality associated with geriatric anesthesia in China should be reported promptly. In the future, the perspective of geriatric anesthesia needs to be expanded into perioperative geriatric medicine to improve the perioperative management strategy based on the postoperative outcome-directed concept transformation.
Conclusions:
Anesthesiologists should evaluate the physiological and medical status and focus on the prevention of potential complications in the perioperative setting with the goal to enhance elderly patients’ long-term well-being and survival quality.
Viewpoint
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患者教育提高了中国农村患者对丙型肝炎抗病毒治疗的知识和接受度Yang Ming, Rao Hui-Ying, Feng Bo, Wu Elizabeth, Wei Lai, Lok Anna S
中华医学杂志英文版2017年 130卷 22期
DOI: 10.4103/0366-6999.218023
摘要
据估计，全世界有1.3亿-1.5亿人慢性感染丙型肝炎病毒（HCV）。在20世纪80年代末和90年代初，非法商业血浆或献血行为在中国选定的农村地区很常见，这导致了HCV感染的快速传播。横断面研究表明，以前有偿血浆或献血者的HCV感染率从9.6%到72.8%不等。慢性HCV感染可导致肝硬化、肝衰竭和肝细胞癌（HCC），是一个主要的全球健康问题。根除HCV可以预防肝硬化、HCC和死亡的失代偿。[
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反馈期刊俱乐部的应用Yu Nan-Ze, Yu Pan-Xi, Wang Xiao-Jun, Long Xiao, Yang Elan, Huang Jiu-Zuo, Wang Yang, Kang Wei-Ming, Jiang Ying-Zi, Li Kang 等
中华医学杂志英文版2017年 130卷 22期
DOI: 10.4103/0366-6999.218009
摘要
1875年，麦吉尔大学的威廉·奥斯勒组织了第一个有记录的期刊俱乐部，以一种经济有效的方式让员工了解医学科学。[
Clinical Observation
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1例肺腺癌患者在纳武单抗治疗后出现严重肺炎并伴有急性肺栓塞Liao Ji-Ping, Nie Li-Gong, Que Cheng-Li, Mu Xiang-Dong
中华医学杂志英文版2017年 130卷 22期
DOI: 10.4103/0366-6999.218005
摘要
一名75岁汉族男性，有1天急性呼吸急促病史。病史包括肺腺癌、乙型肝炎病毒（携带者）、高血压、既往深静脉血栓形成（DVT）、吸烟45年、饮酒35年。5年前行右上叶、中叶及纵隔淋巴结清扫术，术后3个月出现胸膜及多发性肺转移。表皮生长因子受体、KRAS和间变性淋巴瘤激酶重排的分子检测均为阴性。他因肺转移接受了33个周期的化疗和2个疗程的放疗。然而，他仍然出现双侧肺转移和多个胸椎和腰椎转移。在当前表现前六周，他接受了纳武单抗（每2周3 mg/kg，3个周期）。
Clinical Challenge
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1例肺结核病和腹腔结核患者的Wernicke脑病Gan Yun-Cui, Jin Jing, Qiu Zhi-Xin, Chen Xue-Rong
中华医学杂志英文版2017年 130卷 22期
DOI: 10.4103/0366-6999.218010
摘要
韦尼克脑病（WE）是一种由硫胺素（维生素B1）缺乏引起的急性或亚急性神经系统综合征，在临床实践中通常被低估。仅约6%的非酒精患者和三分之一的酒精患者怀疑WE。[
Clinical Picture
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连锁彩色成像技术诊断胃粘膜相关淋巴组织淋巴瘤Deng Pei, Min Min, Ma Cui-Yun, Liu Yan
中华医学杂志英文版2017年 130卷 22期
DOI: 10.4103/0366-6999.214137
摘要
粘膜相关淋巴组织（MALT）淋巴瘤以前只能通过胃标本的组织学检查来诊断，这使得MALT淋巴瘤的诊断非常困难。胃MALT淋巴瘤的内镜表现是可变的，由于其组织形态学相似性，目前常规的白光内镜检查不能区分MALT淋巴瘤的癌组织和炎症。已经开发了一种新的内窥镜方式，称为连锁彩色成像（LCI），可能有助于胃MALT淋巴瘤的诊断。在此，我们报告了一例由LCI诊断的MALT淋巴瘤。男，66岁，在军事医学科学院附属医院行上消化道内镜检查。结果显示，在胃体的大曲率处有一个大小约为15mm的纵向肥大胃皱襞，白光成像正常[WLI；
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胸椎Kovalevsky管后纵隔、椎管内、硬膜内、髓内脂肪瘤Ren Da-Jiang, Mauer Uwe Max, Kunz Ulrich, Li Fang, Sun Tian-Sheng
中华医学杂志英文版2017年 130卷 22期
DOI: 10.4103/0366-6999.218001
摘要
脊柱脂肪瘤是良性肿瘤，通常分为硬膜外型和硬膜内型。总之，60%位于硬膜内，40%位于硬膜外。已知最常见的脊柱脂肪瘤与腰骶部的骨不连有关。[
Correspondence
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正电子发射断层扫描上无氟脱氧葡萄糖摄取的早期多原发性肺癌-计算机断层扫描显示不同EGFR分子谱Liu Chang, An Yun-Xia, Ma Li-Jun, Zhang Xiao-Ju
中华医学杂志英文版2017年 130卷 22期
DOI: 10.4103/0366-6999.218014
摘要
致编者：多原发肺癌（MPLC）是指单个患者同时或异时出现一个以上的原发肺癌。MPLC的诊断很复杂，仅根据放射学和组织病理学标准通常很难将MPLC与转移性肺癌区分开来。此外，早期MPLC和转移性肺癌的治疗方案和预后有很大不同。
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副肿瘤性抗N-甲基-D-天冬氨酸受体脑炎Niu Chi, Guo Wei
中华医学杂志英文版2017年 130卷 22期
DOI: 10.4103/0366-6999.218020
摘要
致编者：抗N-甲基-D-天冬氨酸受体(NMDAR)脑炎是一种严重的自身免疫性疾病。Dalmau在该患者群体中鉴定出抗海马和前额叶神经细胞膜NMDAR抗体，并首次命名了该综合征。[
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1A型Charcot-Marie-Tooth病脊神经根肥大的一种罕见磁共振图像征象An Hong, Li Jun, Wang Lei-Ming, Cui Bo, Piao Yue-Shan, Ren Yan-Jun, Chen Hai, Wang Yu-Ping, Wu Li-Yong
中华医学杂志英文版2017年 130卷 22期
DOI: 10.4103/0366-6999.218017
摘要
编者按：腓骨肌萎缩症（CMT）是一种临床和遗传异质性遗传性神经病，以1A型最为常见。CMT 1A的特征是从腓骨组开始的肢体远端肌肉进行性无力和萎缩，轻度远端感觉丧失，腱反射减弱，神经传导速度减慢。[
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指甲花纹身：暂时还是永久？Peng Fen, Du Juan, Xue Chen-Hong, Liu Shuo-Shuo, Li Wen-Hai, Chen Zhou, Zhang Jian-Zhong
中华医学杂志英文版2017年 130卷 22期
DOI: 10.4103/0366-6999.218003
摘要
致编辑：指甲花纹身已经变得流行，并且越来越多地被报道为皮肤过敏反应的原因。描述了中国3例指甲花纹身引起的接触性皮炎。
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c.532G>A突变引起的中国囊性纤维化婴儿假性巴特综合征CFTRYao Yao, Feng Xue-Li, Xu Bao-Ping, Shen Kun-Ling
中华医学杂志英文版2017年 130卷 22期
DOI: 10.4103/0366-6999.218015
摘要
致编者：我们报告了一例中国6个月大女婴囊性纤维化（CF）伴假性巴特综合征（PBS）的病例。她在3个月大时“普通感冒”后开始反复咳嗽和喘息，并因“肺炎”多次住院。她接受了口服抗生素和雾化支气管扩张剂，但没有改善。此外，她还出现了低钾血症（2.5 mmol/L）和代谢性碱中毒。她被转移到我们医院接受持续治疗。她的出生史并不复杂。她是血亲父母所生的第四个孩子。她的哥哥在13岁时死于严重的肺炎和支气管扩张。她的姐姐在6岁时被诊断为哮喘，目前控制良好。体格检查显示中度脱水，发育不良（3研发百分位数），听诊时弥漫性隆奇。计算机断层扫描(CT)显示右肺有散在浸润和轻度实变[
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