MedNexus
2019年 · 第132卷第05期
出版日期 2019-03-05电子版 ￥0.00元
MedNexus
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Original Article
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中国大量人群妊娠期甲状腺功能参考范围及其与现行指南的比较Xi Yang, Yu Meng, Yong Zhang, Chen Zhang, Fei Guo, Shuai Yang, Rong Ding, Jian-Xia Fan
中华医学杂志英文版2019年 132卷 05期
DOI: 10.1097/CM9.0000000000000051
摘要
Background:
A correct thyroid function reference range is important for the accurate diagnosis of thyroid disease during pregnancy. However, there is no consensus on whether thyroid function reference ranges in Chinese population should follow the America Thyroid Association (ATA) guidelines. This study aimed to establish a thyroid function reference range more suited to the Chinese population by evaluating the current thyroid function reference range in pregnant Chinese women and comparing it to the ATA guidelines.
Methods:
A total of 52,027 pregnant women were enrolled from January 2013 to December 2016. Thyroid stimulating hormone (TSH), free thyroxine (FT4), and thyroid peroxidase antibody (TPOAb) levels were tested during the first and third trimesters of pregnancy. Reference ranges of TSH and FT4 were established from the 2.5th and 97.5th percentiles of the TPOAb-negative population of women. The Mann-Whitney U test was used to compare thyroid hormones between the TPOAb-positive and TPOAb-negative groups.
Results:
We obtained that the TSH reference ranges were 0.03 to 3.52 mU/L and 0.39 to 3.67 mU/L, and the FT4 reference ranges were 11.7 to 19.7 pmol/L and 9.1 to 14.4 pmol/L, in the first and third trimester, respectively. If we used the 2011 ATA criteria about 7.0% and 4.0% pregnant women would be over diagnosed in first and third trimester, respectively, compared with local population thyroid hormone reference. When we compared our local criteria with the new 2017 ATA criteria, about 1.2% and 0.8% pregnant women would have a missed diagnosis in first and third trimester, respectively.
Conclusions:
Based on our data, which is in line with the current ATA guidelines, a population-based thyroid function reference range would be the first choice for diagnosis of thyroid disease during pregnancy in China. In case such population-based thyroid function reference ranges are unavailable in the east of China, our reference ranges can be adopted, if the same assay is used.
Trial Registration:
www.chictr.org.cn (No. ChiCTR1800014394).
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不同估计肾小球滤过率方程对中国百岁老人慢性肾脏病分期的分析Qiu-Xia Han, Dong Zhang, Ya-Li Zhao, Liang Liu, Jing Li, Fu Zhang, Fu-Xin Luan, Jia-Yu Duan, Zhang-Suo Liu, Guang-Yan Cai 等
中华医学杂志英文版2019年 132卷 05期
DOI: 10.1097/CM9.0000000000000079
摘要
Background:
Accurate estimation of the glomerular filtration rate (GFR) and staging of chronic kidney disease (CKD) are important. Currently, there is no research on the differences in several estimated GFR equations for staging CKD in a large sample of centenarians. Thus, this study aimed to investigate the differences in CKD staging with the most commonly used equations and to analyze sources of discrepancy.
Methods:
A total of 966 centenarians were enrolled in this study from June 2014 to December 2016 in Hainan province, China. The GFR with the Modification of Diet in Renal Disease (MDRD), Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) and Berlin Initiative Study 1 (BIS1) equations were estimated. Agreement between these equations was investigated with the κ statistic and Bland-Altman plots. Sources of discrepancy were investigated by partial correlation analysis.
Results:
The κ values of the MDRD and CKD-EPI equations, MDRD and BIS1 equations, and CKD-EPI and BIS1 equations were 0.610, 0.253, and 0.381, respectively. Serum creatinine (Scr) explained 10.96%, 41.60% and 17.06% of the variability in these three comparisons, respectively. Serum uric acid (SUA) explained 3.65% and 5.43% of the variability in the first 2 comparisons, respectively. Gender was associated with significant differences in these 3 comparisons (P < 0.001).
Conclusions:
The strengths of agreement between the MDRD and CKD-EPI equations were substantial, but those between the MDRD and BIS1 equations and the CKD-EPI and BIS1 equations were fair. The difference in CKD staging of the first 2 comparisons strongly depended on Scr, SUA and gender, and that of CKD-EPI and BIS1 equations strongly depended on Scr and gender. The incidence at various stages of CKD staging was quite different. Thus, a new equation that is more suitable for the elderly needs to be built in the future.
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根据心电图ST段抬高的急性心肌梗死患者症状和院前延迟的差异：中国急性心肌梗死(CAMI)登记处的分析Rui Fu, Chen-Xi Song, Ke-Fei Dou, Jin-Gang Yang, Hai-Yan Xu, Xiao-Jin Gao, Qian-Qian Liu, Han Xu, Yue-Jin Yang
中华医学杂志英文版2019年 132卷 05期
DOI: 10.1097/CM9.0000000000000122
摘要
Background:
Approximately 70% patients with acute myocardial infarction (AMI) presented without ST-segment elevation on electrocardiogram. Patients with non-ST segment elevation myocardial infarction (NSTEMI) often presented with atypical symptoms, which may be related to pre-hospital delay and increased risk of mortality. However, up to date few studies reported detailed symptomatology of NSTEMI, particularly among Asian patients. The objective of this study was to describe and compare symptoms and presenting characteristics of NSTEMI vs. STEMI patients.
Methods:
We enrolled 21,994 patients diagnosed with AMI from China Acute Myocardial Infarction (CAMI) Registry between January 2013 and September 2014. Patients were divided into 2 groups according to ST-segment elevation: ST-segment elevation (STEMI) group and NSTEMI group. We extracted data on patients’ characteristics and detailed symptomatology and compared these variables between two groups.
Results:
Compared with patients with STEMI (N= 16,315), those with NSTEMI (N= 5679) were older, more often females and more often have comorbidities. Patients with NSTEMI were less likely to present with persistent chest pain (54.3% vs. 71.4%), diaphoresis (48.6% vs. 70.0%), radiation pain (26.4% vs. 33.8%), and more likely to have chest distress (42.4% vs. 38.3%) than STEMI patients (all P < 0.0001). Patients with NSTEMI were also had longer time to hospital. In multivariable analysis, NSTEMI was independent predictor of presentation without chest pain (odds ratio: 1.974, 95% confidence interval: 1.849–2.107).
Conclusions:
Patients with NSTEMI were more likely to present with chest distress and pre-hospital patient delay compared with patients with STEMI. It is necessary for both clinicians and patients to learn more about atypical symptoms of NSTEMI in order to rapidly recognize myocardial infarction.
Trial Registration:
www.clinicaltrials.gov (No. NCT01874691).
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血清抗核抗体的存在与慢性淋巴细胞白血病患者不良总生存期相关Qian Sun, Li Wang, Hua-Yuan Zhu, Yi Miao, Wei Wu, Jin-Hua Liang, Lei Cao, Yi Xia, Jia-Zhu Wu, Yan Wang 等
中华医学杂志英文版2019年 132卷 05期
DOI: 10.1097/CM9.0000000000000114
摘要
Background:
Serum antinuclear antibodies (ANAs) are positive in some patients with chronic lymphocytic leukemia (CLL), but the prognostic value of ANAs remains unknown. The aim of this study was to evaluate the role of ANAs as a prognostic factor in CLL.
Methods:
This study retrospectively analyzed clinical data from 216 newly diagnosed CLL subjects with ANAs test from 2007 to 2017. Multivariate Cox regression analyses were used to screen the independent prognostic factors related to time to first treatment (TTFT), progression free survival (PFS) and overall survival (OS). Receiver operator characteristic curves and area under the curve (AUC) were utilized to assess the predictive accuracy of ANAs together with other independent factors for OS.
Results:
The incidence of ANAs abnormality at diagnosis was 13.9%. ANAs positivity and TP53 disruption were independent prognostic indicators for OS. The AUC of positive ANAs together with TP53 disruption was 0.766 (95% confidence interval [CI]: 0.697–0.826), which was significantly larger than that of either TP53 disruption (AUC: 0.706, 95% CI: 0.634–0.772, P= 0.034) or positive ANAs (AUC: 0.595, 95% CI: 0.520–0.668, P < 0.001) in OS prediction. Besides, serum positive ANAs as one additional parameter to CLL-international prognostic index (IPI) obtained superior AUCs in predicting CLL OS than CLL-IPI alone.
Conclusion:
This study identified ANAs as an independent prognostic factor for CLL, and further investigations are needed to validate this finding.
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300 Hz低通滤波器改善了远程和床旁心电图上起搏器尖峰的检测Jian Sun, Qiu-Feng Lu, Yan Zhao, Peng-Pai Zhang, Jun Wang, Qun-Shan Wang, Xiao-Hong Liu, Yi-Gang Li
中华医学杂志英文版2019年 132卷 05期
DOI: 10.1097/CM9.0000000000000110
摘要
Background:
The current upper-frequency cutoff of 150 Hz sometimes causes loss of pacemaker spike and misdiagnosis. We hypothesized that low-pass filter (LPF) other than 150 Hz could improve the detection of pacemaker spike. This study aimed to examine the effect of different LPF on pacemaker spike detection in remote and bedside electrocardiogram (ECG).
Methods:
Patients with permanent pacemaker implantation were included during routine follow-up. Standard 12-lead ECGs at 6 different upper-frequency cutoff (40, 100, 150, 200, 300, and 400 Hz) were collected. All ECGs were then transmitted to the remote clinic center. Ventricular and atrial pacing were analyzed by 2 independent medical practitioners.
Results:
A total of 88 patients’ ECGs were analyzed (mean age 73.8 ± 10.2 years and 85 with dual-chamber pacemakers). About 75.3% (64/85) of patients were diagnosed as atrial pacing by pacemaker programming. Among 6 different upper-frequency cutoff, the 300 Hz turned out to perform best in detecting atrial-paced spike (area under the curve [AUC] = 0.73, 95% confidence interval [CI]: 0.61–0.84 vs. 0.56, 95% CI: 0.61–0.84 at 150 Hz; P= 0.002) on bedside ECGs. Using programming as the golden standard, the 300 Hz LPF has a sensitivity of 59.4%, specificity of 85.7%, positive predictive value of 92.7% and negative predictive value of 40.9% on bedside ECGs. As for the ventricular pacing, the 300 Hz LPF also had a higher accuracy (AUC= 0.93; 95% CI = 0.84-1.00) than that at 150 Hz (AUC= 0.86; 95% CI: 0.77–0.94; P < 0.001) in detecting ventricular-paced spike on bedside ECGs. The results of remote ECGs were similar with bedside ECGs.
Conclusions:
A filter of 300 Hz cutoff may be recommended for ECG spike detection. With the recommended parameter, remote ECG can perform as well as bedside ECG.
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肌萎缩侧索硬化重复神经刺激波形变化趋势的研究Li-Lan Fu, He-Xiang Yin, Ming-Sheng Liu, Li-Ying Cui
中华医学杂志英文版2019年 132卷 05期
DOI: 10.1097/CM9.0000000000000117
摘要
Background:
Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease involving both upper and lower motor neurons with no effective cure. Electrophysiological studies have found decremental responses during low-frequency repetitive nerve stimulation (RNS) except for diffused neurogenic activities. However, the difference between ALS and generalized myasthenia gravis (GMG) in terms of waveform features is unclear. In the current study, we explored the variation trend of the amplitudes curve between ALS and GMG with low-frequency, positive RNS, and the possible mechanism is discussed preliminarily.
Methods:
A total of 85 ALS patients and 41 GMG patients were recruited. All patients were from Peking Union Medical College Hospital (PUMCH) between July 1, 2012 and February 28, 2015. RNS study included ulnar nerve, accessory nerve and facial nerve at 3 Hz and 5 Hz stimulation. The percentage reduction in the amplitude of the fourth or fifth wave from the first wave was calculated and compared with the normal values of our hospital. A 15% decrease in amplitude is defined as a decrease in amplitude.
Results:
The decremental response at low-frequency RNS showed the abnormal rate of RNS decline was 54.1% (46/85) in the ALS group, and the results of different nerves were 54.1% (46/85) of the accessory nerve, 8.2% (7/85) of the ulnar nerve and 0% (0/85) of the facial nerve stimulation, respectively. In the GMG group, the abnormal rate of RNS decline was 100% (41/41) at low-frequency RNS of accessory nerves. However, there was a significant difference between the 2 groups in the amplitude after the sixth wave.
Conclusions:
Both groups of patients are able to show a decreasing amplitude of low-frequency stimulation RNS, but the recovery trend after the sixth wave has significant variation. It implies the different pathogenesis of NMJ dysfunction of these 2 diseases.
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Ki-67指数的自动定量与肺神经内分泌肿瘤病理分级的相关性Hai-Yue Wang, Zhong-Wu Li, Wei Sun, Xin Yang, Li-Xin Zhou, Xiao-Zheng Huang, Ling Jia, Dong-Mei Lin
中华医学杂志英文版2019年 132卷 05期
DOI: 10.1097/CM9.0000000000000109
摘要
Background:
Classification of the pulmonary neuroendocrine tumor (pNET) categories is a step-wise process identified by the presence of necrosis and number of mitoses per 2 mm2. In neuroendocrine tumor pathology, Ki-67 was first described as a prognostic factor in the pancreas and incorporated into the grading system of digestive tract neuroendocrine neoplasms in the 2010 WHO classification. However, the significance of Ki-67 in pNETs was still a controversial issue. This study was to investigate the potentially diagnostic value of Ki-67 in pNETs.
Methods:
We retrieved 159 surgical specimens of pNETs, including 35 typical carcinoids (TCs), 2 atypical carcinoid (ACs), 28 large-cell neuroendocrine carcinomas (LCNECs), 94 small-cell lung cancers (SCLCs). Manual conventional method (MCM) and computer-assisted image analysis method (CIAM) were used to calculate the Ki-67 proliferative index. In CIAM, 6 equivalent fields (500 × 500 μm) at 10× magnification were manually annotated for digital image analysis.
Results:
The Ki-67 index among the 4 groups with ranges of 0.38% to 12.66% for TC, 4.34% to 29.48% for AC, 30.67% to 93.74% for LCNEC, and 40.71% to 96.87% for SCLC. The cutoff value of Ki-67 index to distinguish low grade with high grade was 30.07%. For the univariate survival analyses in pNETs, both the overall survival and progression-free survival correlated with Ki-67 index. In addition, the Ki-67 index performed by CIAM was proved to be of great positive correlation with MCM.
Conclusions:
Ki-67 index counted by CIAM is a reliable method and can be a useful adjunct to classify the low- and high-grade NETs.
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三维超短回波时间锥序列对膝关节钙化软骨区的磁共振成像Jin Liu, Yang Wei, Ya-Jun Ma, Yan-Chun Zhu, Quan Zhou, Ying-Hua Zhao
中华医学杂志英文版2019年 132卷 05期
DOI: 10.1097/CM9.0000000000000103
摘要
Background:
The zone of calcified cartilage (ZCC) plays an important role in the pathogenesis of osteoarthritis (OA) but has never been imaged in vivo with magnetic resonance (MR) imaging techniques. We investigated the feasibility of direct imaging of the ZCC in both cadaveric whole knee specimens and in vivo healthy knees using a 3-dimensional ultrashort echo time cones (3D UTE-Cones) sequence on a clinical 3T scanner.
Methods:
In all, 12 cadaveric knee joints and 10 in vivo healthy were collected. At a 3T MR scanner with an 8-channel knee coil, a fat-saturated 3D dual-echo UTE-Cones sequence was used to image the ZCC, following with a short rectangular pulse excitation and 3D spiral sampling with conical view ordering. The regions of interests (ROIs) were delineated by a blinded observer. Single-component T2* and T2 values were calculated from fat-saturated 3D dual-echo UTE-Cones and a Carr-Purcell-Meiboom-Gill (T2 CPMG) data using a semi-automated MATLAB code.
Results:
The single-exponential fitting curve of ZCC was accurately obtained with R2 of 0.989. For keen joint samples, the ZCC has a short T2* ranging from 0.62 to 2.55 ms, with the mean ± standard deviation (SD) of 1.49 ± 0.66 ms, and with 95% confidence intervals (CI) of 1.20–1.78 ms. For volunteers, the short T2* ranges from 0.93 to 3.52 ms, with the mean ± SD of 2.09 ± 0.56 ms, and the 95% CI is 1.43 to 2.74 ms in ZCC.
Conclusions:
The high-resolution 3D UTE-Cones sequence might be used to directly image ZCC in the human knee joint on a clinical 3T scanner with a scan time of more than 10 min. Using this non-invasive technique, the T2* relaxation time of the ZCC can be further detected.
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Cathelicidin LL-37恢复吸烟和脂多糖诱导的大鼠气道炎症的糖皮质激素功能Jian-Zhen Weng, Yan Wang, Tie-Ying Sun
中华医学杂志英文版2019年 132卷 05期
DOI: 10.1097/CM9.0000000000000107
摘要
Background
Glucocorticoids have been widely used to treat patients with chronic obstructive pulmonary disease (COPD). Nevertheless, corticosteroid insensitivity is a major barrier to the effective treatment of COPD and its mechanism remains unclear. This study aimed to evaluate the effect of cathelicidin LL-37 on corticosteroid insensitivity in COPD rat model, and to explore the involved mechanisms.
Methods
COPD model was established by exposing male Wistar rats to cigarette smoke combined with intratracheal instillation of lipopolysaccharide (LPS). Inhaled budesonide and LL-37 were consequently applied to COPD models separately or collectively to confirm the effects on inflammatory cytokines (tumor necrosis factor [TNF]-α and transforming growth factor [TGF]-β) by enzyme-linked immunosorbent assay (ELISA) and lung tissue histopathological morphology. Expression of histone deacetylase-2 (HDAC2) and phosphorylation of Akt (p-AKT) in lung were also measured.
Results
Briefly, COPD model rats showed an increased basal release of inflammatory cytokines (lung TNF-α: 45.7 ± 6.1 vs. 20.1 ± 3.8 pg/mL, P < 0.01; serum TNF-α: 8.9 ± 1.2 vs. 6.7 ± 0.5 pg/mL, P= 0.01; lung TGF-β: 122.4 ± 20.8 vs. 81.9 ± 10.8 pg/mL, P < 0.01; serum TGF-β: 38.9 ± 8.5 vs. 20.6 ± 2.3 pg/mL, P < 0.01) and COPD related lung tissue histopathological changes, as well as corticosteroid resistance molecular profile characterized by an increase in phosphoinositide 3-kinase (PI3K)/Akt (0.5 ± 0.1 fold of control vs. 0.2 ± 0.1 fold of control, P= 0.04) and a decrease in HDAC2 expression and activity (expression: 13.1 ± 0.4 μmol/μg vs. 17.4 ± 1.1 μmol/μg, P < 0.01; activity: 1.1 ± 0.1 unit vs. 1.4 ± 0.1 unit, P < 0.01), compared with control group. In addition, LL-37 enhanced the anti-inflammatory effect of budesonide in an additive manner. Treatment with combination of inhaled corticosteroids (ICS) and LL-37 led to a significant increase of HDAC2 expression and activity (expression: 15.7 ± 0.4 μmol/μg vs. 14.1 ± 0.9 μmol/μg, P < 0.01; activity: 1.3 ± 0.1 unit vs. 1.0 ± 0.1 unit, P < 0.01), along with decrease of p-AKT compared to budesonide monotherapy (0.1 ± 0.0 fold of control vs. 0.3 ± 0.1 fold of control, P < 0.01).
Conclusions
This study suggested that LL-37 could improve the anti-inflammatory activity of budesonide in cigarette smoke and LPS-induced COPD rat model by enhancing the expression and activity of HDAC2. The mechanism of this function of LL-37 might involve the inhibition of PI3K/Akt pathway.
Meta Analysis
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抗纤溶药物在脊柱手术中的疗效和安全性：一项网络荟萃分析Lei Yuan, Yan Zeng, Zhong-Qiang Chen, Xin-Ling Zhang, Shuo Mai, Pan Song, Li-Yuan Tao
中华医学杂志英文版2019年 132卷 05期
DOI: 10.1097/CM9.0000000000000108
摘要
Background:
Significant blood loss is still one of the most frequent complications in spinal surgery, which often necessitates blood transfusion. Massive perioperative blood loss and blood transfusion can create additional risks. Aprotinin, tranexamic acid (TXA), and epsilon-aminocaproic acid (EACA) are antifibrinolytics currently offered as prophylactic agents to reduce surgery-associated blood loss. The aim of this study was to evaluate the efficacy and safety of aprotinin, EACA, and low/high doses of TXA in spinal surgery, and assess the use of which agent is the most optimal intervention using the network meta-analysis (NMA) method.
Methods:
Five electronic databases were searched, including PubMed, Cochrane Library, ScienceDirect, Embase, and Web of Science, from the inception to March 1, 2018. Trials that were randomized and compared results between TXA, EACA, and placebo were identified. The NMA was conducted with software R 3.3.2 and STATA 14.0.
Results:
Thirty randomized controlled trial (RCT) studies were analyzed. Aprotinin (standardized mean difference [SMD]=－0.65, 95% credibility intervals [CrI;－1.25, －0.06]), low-dose TXA (SMD=－0.58, 95% CrI [－0.92, －0.25]), and high-dose TXA (SMD= －0.70, 95% CrI [－1.04, －0.36]) were more effective than the respective placebos in reducing intraoperative blood loss. Low-dose TXA (SMD=－1.90, 95% CrI [－3.32, －0.48]) and high-dose TXA (SMD=－2.31, 95% CrI [－3.75, －0.87]) had less postoperative blood loss. Low-dose TXA (SMD=－1.07, 95% CrI [－1.82, －0.31]) and high-dose TXA (SMD=－1.07, 95% CrI [－1.82, －0.31]) significantly reduced total blood loss. However, only high-dose TXA (SMD = －2.07, 95% CrI [－3.26, －0.87]) was more effective in reducing the amount of transfusion, and was significantly superior to low-dose TXA in this regard (SMD= －1.67, 95% CrI [－3.20, －0.13]). Furthermore, aprotinin (odds ratio [OR]= 0.16, 95% CrI [0.05, 0.54]), EACA (OR= 0.46, 95% CrI [0.22, 0.97]) and high dose of TXA (OR= 0.34, 95% CrI [0.19, 0.58]) had a significant reduction in transfusion rates. Antifibrinolytics did not show a significantly increased risk of postoperative thrombosis. Results of ranking probabilities indicated that high-dose TXA had the greatest efficacy and a relatively high safety level.
Conclusions:
The antifibrinolytic agents are able to reduce perioperative blood loss and transfusion requirement during spine surgery. And the high-dose TXA administration might be used as the optimal treatment to reduce blood loss and transfusion.
Review Article
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脓毒症和脓毒性休克的抗感染治疗规则Xiang Zhou, Long-Xiang Su, Jia-Hui Zhang, Da-Wei Liu, Yun Long
中华医学杂志英文版2019年 132卷 05期
DOI: 10.1097/CM9.0000000000000101
摘要
Objective:
Sepsis is a deadly infection that causes injury to tissues and organs. Infection and anti-infective treatment are the eternal themes of sepsis. The successful control of infection is a key factor of resuscitation for sepsis and septic shock. This review examines evidence for the treatment of sepsis. This evidence is combined with clinical experiments to reveal the rules and a standard flowchart of anti-infection therapy for sepsis.
Data Sources:
We retrieved information from the PubMed database up to October 2018 using various search terms and their combinations, including sepsis, septic shock, infection, antibiotics, and anti-infection.
Study Selection:
We included data from peer-reviewed journals printed in English on the relationships between infections and antibiotics.
Results:
By combining the literature review and clinical experience, we propose a 6Rs rule for sepsis and septic shock management: right patients, right time, right target, right antibiotics, right dose, and right source control. This rule encompasses rational decisions regarding the timing of treatment, the identification of the correct pathogen, the selection of appropriate antibiotics, the formulation of a scientifically based antibiotic dosage regimen, and the adequate control of infectious foci.
Conclusions:
This review highlights how to recognize and treat sepsis and septic shock and provides rules and a standard flowchart for anti-infection therapy for sepsis and septic shock for use in the clinical setting.
Clinical Observation
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白质连接受损，而不是皮质激活，导致线粒体脑肌病伴乳酸酸中毒和中风样发作的语言功能障碍Na Ye, Jing-Yi Liu, Xi-Ping Gong, Hui Qu, Ke-Hui Dong, Yan-Ling Ma, Wei-Li Jia, Zhao-Zhao Wang, Yuan-Jun Li, Yu-Mei Zhang
中华医学杂志英文版2019年 132卷 05期
DOI: 10.1097/CM9.0000000000000105
摘要
线粒体脑肌病伴乳酸酸中毒和卒中样发作（MELAS）是一种以高乳酸血症和卒中样症状为特征的代谢紊乱。[
Correspondence
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小说DOCK7一例中国早期婴儿癫痫性脑病患者的突变23Bing Bai, Yi-Ran Guo, Yin-Hong Zhang, Chan-Chan Jin, Jin-Man Zhang, Hong Chen, Bao-Sheng Zhu
中华医学杂志英文版2019年 132卷 05期
DOI: 10.1097/CM9.0000000000000100
摘要
致编辑：早期婴儿癫痫性脑病23（EIEE23；OMIM#615859）是一种罕见的（<全球1/1,000，000）一种遗传性常染色体隐性疾病。EIEE23患者的特征是2至6个月大的顽固性癫痫发作、脑电图(EEG)上的多灶性癫痫活动、精神运动发育迟缓和皮质失明或视力损害。[
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钩突粘液腺囊肿Chun-Yu Wang, Bei-Bei Wang, Xiao-Long Yao, Fen Zhang, Yuan-Yang Zhao, Zhi-Yun Li, Qing-Quan Zhang
中华医学杂志英文版2019年 132卷 05期
DOI: 10.1097/CM9.0000000000000104
摘要
致编辑：鼻窦粘液腺囊肿常见，但钩突大型粘液腺囊肿国内外未见报道。我们报告一例罕见的钩突粘液腺囊肿，以提高对钩突粘液腺囊肿的认识。
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听觉语言幻觉健康个体的脑白质和功能网络受损Xiao-Dong Lin, De-Guo Jiang, Lang-Lang Cheng, Ce Chen, Chong-Guang Lin, Chuan-Jun Zhuo
中华医学杂志英文版2019年 132卷 05期
DOI: 10.1097/CM9.0000000000000106
摘要
致编辑：听觉言语幻觉(AVH)伴随着各种神经精神病学诊断，包括精神分裂症、双相情感障碍、重度抑郁症、创伤后应激障碍和边缘型人格障碍。[
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大基因组分析诊断异基因造血干细胞移植后脑弓形虫病Kai Shen, Ting Liu, Jie Ji
中华医学杂志英文版2019年 132卷 05期
DOI: 10.1097/CM9.0000000000000087
摘要
致编辑：一名19岁中国男性，6个月前因急性T淋巴细胞白血病接受半相合异基因造血干细胞移植（allo-HSCT），评估为构音障碍、呕吐、高热和头痛。鉴定传染性病原体的努力均产生阴性结果，如脑脊液（CSF）培养、血清弓形虫抗体、血清半乳甘露聚糖抗原测定、（1, 3）-β-D-葡聚糖抗原测定和结核病（TB）干扰素γ释放测定。他的脑磁共振成像（MRI）在T2序列显示多灶性肿块和结节性混合密度病变，并伴有明显的外周水肿。在增强T1序列中观察到明显的偏心靶征[
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左心房粘液瘤致急性脑梗死1例Jia-Qi Zhang, Cai-Jun Wu, Li-Qiang Niu
中华医学杂志英文版2019年 132卷 05期
DOI: 10.1097/CM9.0000000000000111
摘要
致编辑：患者为42岁男性，身高178 cm，体重70 kg。他于2018年7月4日因头晕伴有持续的左侧肢体无力共5天入住急诊科。入院前，患者一直在三亚（中国南部）进行密集活动，导致恶心和呕吐。呕吐物为胃内容物。患者逐渐出现身体症状，如左侧四肢无力、左手不稳、手不能举过头顶和左腿无力。这些症状导致难以稳定行走，没有旋转的感觉，昏厥或失去知觉的经历，以及尿失禁。患者转至三亚当地医院就诊。根据病例报告，其血压为90/60 mmHg，血糖为5.0 mmol/L。诊断结果为“低血压、低血糖”。给予葡萄糖、维生素C和氯化钾作为治疗，症状反过来略有改善。患者返京后入住我院（东直门医院）急诊科复查。其头颅MRI+DWI提示双侧额叶、右顶叶、侧脑室、基底节、丘脑、颞顶叶多发性急性和亚急性脑梗死。因此，患者被诊断为患有“急性脑梗死”。
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ST段抬高型心肌梗死和心源性休克患者非梗死相关动脉病变血运重建策略的新争论：解码罪魁祸首-休克试验，不足以挑战现行指南Fang Song, Qiang Wu, Xiao-Ping Chen
中华医学杂志英文版2019年 132卷 05期
DOI: 10.1097/CM9.0000000000000112
摘要
致编辑：罪犯休克审判的研究成果[
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肝细胞癌诊断为面部皮肤转移存活18个月1例Jing-Xin Zeng, Xin Tian, Hui-Lan Zhu, Xi-Bao Zhang, Quan Luo
中华医学杂志英文版2019年 132卷 05期
DOI: 10.1097/CM9.0000000000000083
摘要
致编辑：内部恶性肿瘤的皮肤转移并不常见。其临床表现是可变的，尽管它很少见于肝细胞癌（HCC）。[
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活体供肾短期内移植手术对肾功能的影响Chong-Wei Zhang, Guo Huang, Qing-Wei Wang, Xing-Chao Liu, Ya-Mei Li, Li Wang
中华医学杂志英文版2019年 132卷 05期
DOI: 10.1097/CM9.0000000000000080
摘要
致编辑：来自全球捐赠和移植观察站（GODT）的数据表明，在2015年报告移植的126,670个实体器官中，肾脏占这些器官的66%。[
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左乙拉西坦、氯硝西泮联合治疗MERRF肌阵挛的益处需要进一步证实Josef Finsterer
中华医学杂志英文版2019年 132卷 05期
DOI: 10.1097/CM9.0000000000000042
摘要
致编辑：我们饶有兴趣地阅读了苏的文章等人[
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瓣膜手术后近期死亡率的预测Liu-Jia-Zi Shao, Fu-Shan Xue, Rui-Juan Guo, Li Zheng
中华医学杂志英文版2019年 132卷 05期
DOI: 10.1097/CM9.0000000000000058
摘要
致编辑：陈的单中心视角研究等人[
Comment
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中国Leigh综合征患者的表型和基因型特征Josef Finsterer
中华医学杂志英文版2019年 132卷 05期
DOI: 10.1097/CM9.0000000000000090
摘要
致编辑：我们饶有兴趣地阅读了余的文章等人[
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评《反向腹部成形术联合微型腹部成形术矫正轮廓畸形》Richard J. Zienowicz, Ercan Karacaoglu
中华医学杂志英文版2019年 132卷 05期
DOI: 10.1097/CM9.0000000000000045
摘要
很高兴有机会阅读杨报告的题为“反向腹部成形术联合微型腹部成形术矫正轮廓畸形”的文章等人.[
Author’s Reply
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对“中国Leigh综合征患者的表型和基因型特征”的回复Xiao-Lin Yu, Yu-Ying Zhao
中华医学杂志英文版2019年 132卷 05期
DOI: 10.1097/CM9.00000000000001241
摘要
致编辑：我们非常感谢读者对我们文章的兴趣和评论，并有机会做出解释。[
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