MedNexus
2020年 · 第133卷第11期
出版日期 2020-06-05电子版 ￥0.00元
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Original Article
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Clinical characteristics of fatal and recovered cases of coronavirus disease 2019 in Wuhan, China: a retrospective studyDeng Yan, Liu Wei, Liu Kui, Fang Yuan-Yuan, Shang Jin, Zhou Ling, Wang Ke, Leng Fan, Wei Shuang, Chen Lei 等
中华医学杂志英文版2020年 133卷 11期
DOI: 10.1097/CM9.0000000000000824
摘要
Background:
The 2019 novel coronavirus has caused the outbreak of the acute respiratory disease in Wuhan, Hubei Province of China since December 2019. This study was performed to analyze the clinical characteristics of patients who succumbed to and who recovered from 2019 novel coronavirus disease (COVID-19).
Methods:
Clinical data were collected from two tertiary hospitals in Wuhan. A retrospective investigation was conducted to analyze the clinical characteristics of fatal cases of COVID-19 (death group) and we compare them with recovered patients (recovered group). Continuous variables were analyzed using the Mann-Whitney U test. Categorical variables were analyzed by χ2 test or Fisher exact test as appropriate.
Results:
Our study enrolled 109 COVID-19 patients who died during hospitalization and 116 recovered patients. The median age of the death group was older than the recovered group (69 [62, 74] vs. 40 [33, 57] years, Z = 9.738, P < 0.001). More patients in the death group had underlying diseases (72.5% vs. 41.4%, χ2 = 22.105, P < 0.001). Patients in the death group had a significantly longer time of illness onset to hospitalization (10.0 [6.5, 12.0] vs. 7.0 [5.0, 10.0] days, Z = 3.216, P = 0.001). On admission, the proportions of patients with symptoms of dyspnea (70.6% vs. 19.0%, χ2 = 60.905, P < 0.001) and expectoration (32.1% vs. 12.1%, χ2 = 13.250, P < 0.001) were significantly higher in the death group. The blood oxygen saturation was significantly lower in the death group (85 [77, 91]% vs. 97 [95, 98]%, Z= 10.625, P < 0.001). The white blood cell (WBC) in death group was significantly higher on admission (7.23 [4.87, 11.17] vs. 4.52 [3.62, 5.88] × 109/L, Z = 7.618, P < 0.001). Patients in the death group exhibited significantly lower lymphocyte count (0.63 [0.40, 0.79] vs. 1.00 [0.72, 1.27] ×109/L, Z= 8.037, P < 0.001) and lymphocyte percentage (7.10 [4.45, 12.73]% vs. 23.50 [15.27, 31.25]%, Z = 10.315, P < 0.001) on admission, and the lymphocyte percentage continued to decrease during hospitalization (7.10 [4.45, 12.73]% vs. 2.91 [1.79, 6.13]%, Z= 5.242, P < 0.001). Alanine transaminase (22.00 [15.00, 34.00] vs. 18.70 [13.00, 30.38] U/L, Z = 2.592, P = 0.010), aspartate transaminase (34.00 [27.00, 47.00] vs. 22.00 [17.65, 31.75] U/L, Z = 7.308, P < 0.001), and creatinine levels (89.00 [72.00, 133.50] vs. 65.00 [54.60, 78.75] μmol/L, Z = 6.478, P < 0.001) were significantly higher in the death group than those in the recovered group. C-reactive protein (CRP) levels were also significantly higher in the death group on admission (109.25 [35.00, 170.28] vs. 3.22 [1.04, 21.80] mg/L, Z = 10.206, P < 0.001) and showed no significant improvement after treatment (109.25 [35.00, 170.28] vs. 81.60 [27.23, 179.08] mg/L, Z = 1.219, P = 0.233). The patients in the death group had more complications such as acute respiratory distress syndrome (ARDS) (89.9% vs. 8.6%, χ2 = 148.105, P < 0.001), acute cardiac injury (59.6% vs. 0.9%, χ2 = 93.222, P < 0.001), acute kidney injury (18.3% vs. 0%, χ2 = 23.257, P < 0.001), shock (11.9% vs. 0%, χ2 = 14.618, P < 0.001), and disseminated intravascular coagulation (DIC) (6.4% vs. 0%, χ2 = 7.655, P = 0.006).
Conclusions:
Compared to the recovered group, more patients in the death group exhibited characteristics of advanced age, pre-existing comorbidities, dyspnea, oxygen saturation decrease, increased WBC count, decreased lymphocytes, and elevated CRP levels. More patients in the death group had complications such as ARDS, acute cardiac injury, acute kidney injury, shock, and DIC.
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2008-2017年北京市院前急救护理趋势与特点Huang Wei, Wang Tian-Bing, He Ying-Dong, Zhang Huan, Zhou Xiao-Hua, Liu Hui, Zhang Jin-Jun, Tian Zhen-Biao, Jiang Bao-Guo
中华医学杂志英文版2020年 133卷 11期
DOI: 10.1097/CM9.0000000000000770
摘要
Background:
We aimed to describe and analyze the pre-hospital emergency medical service (EMS) in Beijing and provide information for the government and medical institutions to optimize EMS.
Methods:
We collected all pre-hospital emergency data in Beijing from 2008 to 2017. The chief complaint in each case was classified according to the Medical Priority Dispatch System (MPDS). The sites’ administrative districts were determined through geo-encoding of addresses and then classified into four functional regions. We analyzed the demand for EMS, emergency response times (ERT), and disease spectrum for Beijing as a whole, and for each functional region.
Results:
A total of 4,192,870 pre-hospital EMS cases met the inclusion criteria, with a significant increase (P < 0.001) of 51.60% from 2008 to 2017. EMS demand was positively associated with population (r= 0.946, P < 0.001). The pre-hospital EMS demand rate was 1907.05 in 2008 and 2172.23 in 2017 per 100,000, with no significant change (P = 0.57). ERT increased significantly (P = 0.001), from 19.18 min in 2008 to 24.51 min in 2016. According to MPDS classifications, the demand for pre-hospital care increased for 14 diseases, remained stable for 19, and decreased for only 1 disease. Cases of injury-related disease increased significantly from approximately 90,000 in 2017, accounting for 20% of all pre-hospital EMS cases, and the demand rate decreased in the core region but increased in the sub-urban regions. Cases of heart problems and stroke/transient ischemic attack also increased significantly in the four functional regions, with the highest demand rate in the Core Functional Region.
Conclusions:
More resources and effort should be devoted to pre-hospital EMS according to the increased pre-hospital EMS demand and prolonged ERT in Beijing over our 10-year study period. Changes in disease spectrum and differences between functional regions should also be considered.
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冠状动脉病变的误判及SYNTAX评分反馈对冠状动脉血运重建适宜性的纠正Lin Shen, Zhang Heng, Chen Si-Peng, Rao Chen-Fei, Wu Fan, Zhou Fa-Jun, Wang Yun, Yan Hong-Bing, Dou Ke-Fei, Wu Yong-Jian 等
中华医学杂志英文版2020年 133卷 11期
DOI: 10.1097/CM9.0000000000000827
摘要
Background:
Imprecise interpretation of coronary angiograms was reported and resulted in inappropriate revascularization. Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) score is a comprehensive system to evaluate the complexity of the overall lesions. We hypothesized that a real-time SYNTAX score feedback from image analysts may rectify the mis-estimation and improve revascularization appropriateness in patients with stable coronary artery disease (CAD).
Methods:
In this single-center, historical control study, patients with stable CAD with coronary lesion stenosis ≥50% were consecutively recruited. During the control period, SYNTAX scores were calculated by treating cardiologists. During the intervention period, SYNTAX scores were calculated by image analysts immediately after coronary angiography and were provided to cardiologists in real-time to aid decision-making. The primary outcome was revascularization deemed inappropriate by Chinese appropriate use criteria for coronary revascularization.
Results:
A total of 3245 patients were enrolled and assigned to the control group (08/2016-03/2017, n = 1525) or the intervention group (03/2017-09/2017, n= 1720). For SYNTAX score tertiles, 17.9% patients were overestimated and 4.3% were underestimated by cardiologists in the control group. After adjustment, inappropriate revascularization significantly decreased in the intervention group compared with the control group (adjusted odds ratio [OR]: 0.83; 95% confidence interval [CI]: 0.73-0.95; P = 0.007). Both inappropriate percutaneous coronary intervention (adjusted OR: 0.82; 95% CI: 0.74-0.92; P < 0.001) and percutaneous coronary intervention utilization (adjusted OR: 0.88; 95% CI: 0.79-0.98; P = 0.016) decreased significantly in the intervention group. There was no significant difference in 1-year adverse cardiac events between the control group and the intervention group.
Conclusions:
Real-time SYNTAX score feedback significantly reduced inappropriate coronary revascularization in stable patients with CAD.
Clinical trial registration:
Nos. NCT03068858 and NCT02880605; https://www.clinicaltrials.gov.
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年龄和绝经状态是影响血清人附睾分泌蛋白4水平的重要因素：一项在中国健康人群中的前瞻性横断面研究Cheng Hong-Yan, Zeng Lin, Ye Xue, Ma Rui-Qiong, Tang Zhi-Jian, Chu Hong-Ling, Zhao Yi-Ming, Zhu Li-Rong, Gao Yu-Nong, Chang Xiao-Hong 等
中华医学杂志英文版2020年 133卷 11期
DOI: 10.1097/CM9.0000000000000785
摘要
Background:
Human epididymis secretory protein 4 (HE4) is a new ovarian cancer biomarker. The factors influencing HE4 levels are not clear, and the reference data in China are limited. Here, we aim to evaluate the effects of menopause and age on HE4 levels and to provide a possible reference value for HE4 in healthy Chinese people.
Methods:
A total of 2493 healthy females aged 40 years or older were recruited from March 2013 to March 2017 with the cooperation of four medical institutions across Beijing, China. The serum levels of HE4 and cancer antigen 125 (CA125) were measured by enzyme-linked immunosorbent assay. The Wilcoxon rank-sum test of variance and a stratified analysis were used to analyze the relationships among age, menopausal status, and levels of HE4 or CA125. Confidence intervals (5%-95%) were determined for reference ranges in different populations.
Results:
There was a statistically significant difference in median HE4 levels between the post-menopausal (n = 2168) and premenopausal groups (n = 325) (36.46 vs. 24.04 pmol/L, Z = -14.41, P < 0.001). HE4 increased significantly with age in the post-menopausal groups (H= 408.18, P < 0.001) but not in the pre-menopausal subjects (Z=-0.43, P= 0.67). The upper 95th percentile of HE4 levels were 44.63 pmol/L for pre-menopausal women, 78.17 pmol/L for post-menopausal women, and 73.3 pmol/L for all women. In the post-menopausal population, the HE4 reference ranges were 13.15 to 47.31, 14.31 to 58.04, 17.06 to 73.51, 24.50 to 115.25, and 35.71 to 212.37 pmol/L for different age groups from forty divided by decade. The CA125 level was affected mainly by menopausal status and not age.
Conclusions:
Menopausal status and age were both important factors influencing the level of HE4, and age affected HE4 levels mainly in post-menopausal women. The HE4 level was higher in the post-menopausal population than in the pre-menopausal population and increased with age.
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紧凑型高清晰度二维外窥镜在大型前庭神经鞘瘤手术治疗中的应用Chen Xin, Gao Xiang-Liang, Chai Yan, Shi Ming-Ming, Zhang Jian-Ning, Yue Shu-Yuan
中华医学杂志英文版2020年 133卷 11期
DOI: 10.1097/CM9.0000000000000818
摘要
Background:
Extra-corporeal video telescope operating monitor system provides a necessary instrument to perform high-precision neurosurgical procedures that could substitute or supplement the traditional surgical microscope. The present study was designed to evaluate a compact high-definition two-dimensional exoscope system for assisting in surgical removal of large vestibular schwannoma (VS), as an alternative to a binocular surgical microscope.
Methods:
Patients with Koos grade 3 and grade 4 VS undergoing surgery were enrolled in this prospective cohort study between January 2013 and June 2018. The demographics and tumor characteristics (size, Koos grade, composition [cystic or solid mass]) were matched between the two groups of patients. The following outcome measurements were compared between the two groups: duration of surgery, volume of blood loss, extent of tumor resection, number of operating field adjustments, pre- and post-operative facial and cochlear nerve function evaluated at 3 months post-surgery, complications and surgeons’ comfortability.
Results:
A total of 81 patients received tumor resection through the retrosigmoid approach under either an exoscope (cases, n = 39) or a surgical microscope (control, n = 42). Patients in the two groups had comparable tumor location (P = 0.439), Koos grading (P = 0.867), and composition (P = 0.891). While no significant differences in the duration of surgery (P = 0.172), extent of tumor resection (P = 0.858), facial function (P = 0.838), and hearing ability (P = 1.000), patients operated on under an exoscope had less blood loss (P = 0.036) and a fewer field adjustments (P < 0.001). Both primary and assistant surgeons reported a high level of comfort operating under the exoscope (P = 0.001 and P < 0.001, respectively).
Conclusions:
The compact high-definition two-dimensional exoscope system provides a safe and efficient means to assist in removing large VSs, as compared to a surgical microscope. After the acquaintance with a visual perception through a dynamic hint and stereoscopically viewing corresponding to the motion parallax, the exoscope system provided a comfortable, high-resolution visualization without compromising operational efficiency and patient safety.
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1 α, 25-二羟基维生素D3通过β-catenin途径抑制转化生长因子β 1诱导的上皮-间质转化Xiong Xin-Rong, Tian Xin-Li, Huo Ru-Jie, Dong Yan-Ting, Liu Dai, Bai Jing-Cui, Qi Yun-Feng, Tian Xin-Rui
中华医学杂志英文版2020年 133卷 11期
DOI: 10.1097/CM9.0000000000000830
摘要
Background:
The transforming growth factor β1 (TGF-β1)-induced epithelial-mesenchymal transition (EMT) has been proven associated with the pathogenesis of asthmatic airway remodeling, in which the Wnt/β-catenin pathway plays an important role, notably with regard to TGF-β1. Recent studies have shown that 1α, 25-dihydroxyvitamin D3(1α, 25(OH)2D3) inhibits TGF-β1-induced EMT, although the underlying mechanism have not yet been fully elucidated.
Methods:
Alveolar epithelial cells were exposed to 1α, 25(OH)2D3, ICG-001, or a combination of both, followed by stimulation with TGF-β1. The protein expression of E-cadherin, α-smooth muscle actin, fibronectin, and β-catenin was analyzed by western blotting and immunofluorescence analysis. The mRNA transcript of Snail was analyzed using RT-qPCR, and matrix metalloproteinase 9 (MMP-9) activity was analyzed by gelatin zymogram. The activity of the Wnt/β-catenin signaling pathway was analyzed using the Top/Fop flash reporters.
Results:
Both 1α, 25(OH)2D3 and ICG-001 blocked TGF-β1-induced EMT in alveolar epithelial cells. In addition, the Top/Fop Flash reporters showed that 1α, 25(OH)2D3 suppressed the activity of the Wnt/β-catenin pathway and reduced the expression of target genes, including MMP-9 and Snail, in synergy with ICG-001.
Conclusion:
1α, 25(OH)2D3 synergizes with ICG-001 and inhibits TGF-β1-induced EMT in alveolar epithelial cells by negatively regulating the Wnt/β-catenin signaling pathway.
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辛二酰苯胺异羟肟酸通过10号染色体缺失磷酸酶和张力蛋白同源物介导的细胞凋亡克服厄洛替尼获得性耐药Wu Peng-Fei, Gao Wei-Wei, Sun Cui-Lan, Ma Tai, Hao Ji-Qing
中华医学杂志英文版2020年 133卷 11期
DOI: 10.1097/CM9.0000000000000823
摘要
Background:
Epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs), such as erlotinib and gefitinib, are widely used to treat non-small cell lung cancer (NSCLC). However, acquired resistance is unavoidable, impairing the anti-tumor effects of EGFR-TKIs. It is reported that histone deacetylase (HDAC) inhibitors could enhance the anti-tumor effects of other antineoplastic agents and radiotherapy. However, whether the HDAC inhibitor suberoylanilide hydroxamic acid (SAHA) can overcome erlotinib-acquired resistance is not fully clear.
Methods:
An erlotinib-resistant PC-9/ER cell line was established through cell maintenance in a series of erlotinib-containing cultures. NSCLC cells were co-cultured with SAHA, erlotinib, or their combination, and then the viability of cells was measured by the 3-(4,5-Dimethyl thiazol-2-yl)-2,5-diphenyl tetrazolium bromide assay and apoptosis was determined by flow cytometry and western blotting. Finally, the expression of phosphatase and tensin homolog deleted on chromosome 10 (PTEN) was assessed by western blotting.
Results:
The half-maximal inhibitory concentration of parental PC-9 cells was significantly lower than the established erlotinib-acquired resistant PC-9/ER cell line. PC-9/ER cells demonstrated reduced expression of PTEN compared with PC-9 and H1975 cells, and the combination of SAHA and erlotinib significantly inhibited cell growth and increased apoptosis in both PC-9/ER and H1975 cells. Furthermore, treating PC-9/ER cells with SAHA or SAHA combined with erlotinib significantly upregulated the expression of PTEN mRNA and protein compared with erlotinib treatment alone.
Conclusions:
PTEN deletion is closely related to acquired resistance to EGFR-TKIs, and treatment with the combination of SAHA and erlotinib showed a greater inhibitory effect on NSCLC cells than single-drug therapy. SAHA enhances the suppressive effects of erlotinib in lung cancer cells, increasing cellular apoptosis and PTEN expression. SAHA can be a potential adjuvant to erlotinib treatment, and thus, can improve the efficacy of NSCLC therapy.
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直肠癌长非编码RNA和mRNA表达谱的综合分析Wang De-Zhong, Chen Guan-Yang, Li Yi-Feng, Zhang Neng-Wei
中华医学杂志英文版2020年 133卷 11期
DOI: 10.1097/CM9.0000000000000753
摘要
Background:
Rectal cancer (RC) is a malignant tumor that seriously threatens human health. Long non-coding RNAs (lncRNAs) play a vital role in tumor regulation. Nevertheless, their exact expression features and functions remain obscure, and therefore was the aim of the current study.
Methods:
We utilized the Affymetrix human GeneChip to screen differentially expressed profiles of lncRNAs and mRNAs from the cancer tissues and matched paracancer tissues of 6 RC patients. Gene Ontology (GO) and pathway enrichment analyses identified crucial functions and pathways of the aberrantly expressed mRNAs. We used quantitative real-time polymerase chain reaction to verify the significant expression differences of 11 candidate lncRNAs between the cancer and paracancer tissues. LncRNA-mRNA coexpression networks were built by calculating the Pearson correlation value to identify significant correlation pairs. Online bioinformatics tools GEPIA2, ONCOMINE, and PROGgeneV2 were used to mine the expression and prognosis of three crucial mRNAs and six verified lncRNAs. Competing endogenous RNA networks were constructed by predicting microRNA response elements and calculating free energy.
Results:
We found 1658 differentially expressed lncRNAs (778 up-regulated and 880 down-regulated) and 1783 aberrantly expressed mRNAs (909 up-regulated and 874 down-regulated). GO and pathway enrichment analyses revealed the vital functions of the differentially expressed mRNAs, including cell proliferation, cell migration, angiogenesis, and cellular response to zinc ion. The canonical signaling pathways mainly included the interleukin-17, cell cycle, Wnt, and mineral absorption signaling pathways. Six lncRNAs including AC017002.2 (P= 0.039), cancer susceptibility 19 (CASC19) (P= 0.021), LINC00152 (P= 0.013), NONHSAT058834 (P= 0.007), NONHSAT007692 (P= 0.045), and ENST00000415991.1 (P= 0.045) showed significant differences in expression levels between the cancer tissue and paracancer tissue groups. AC017002.2, NONHSAT058834, NONHSAT007692, and ENST00000415991.1 have not yet been reported in RC. The crucial mRNAs myelocytomatosis viral oncogene (MYC), transforming growth factor beta induced (TGFBI), and solute carrier family 7 member 5 (SLC7A5) were selected. AC017002.2 and LINC00152 were positively correlated with MYC, TGFBI, and cytochrome P450 family 2 sub-family B member 6 (All r > 0.900, P < 0.050). NONHSAT058834 was positively associated with MYC (r = 0.930, P < 0.001), and CASC19 was positively correlated with SLC7A5 (r= 0.922, P < 0.001).
Conclusion:
This study offers convincing evidence of differentially expressed lncRNAs and mRNAs as potential biomarkers in RC.
Consensus Statement
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成人高流量鼻插管氧疗临床规范应用专家共识Xu Jian-Qiao, Su Long-Xiang, Yan Peng, Hu Xing-Shuo, Wen Ruo-Xuan, Xiao Kun, Gu Hong-Jun, Xia Jin-Gen, Sun Bing, Zhou Qing-Tao 等
中华医学杂志英文版2020年 133卷 11期
DOI: 10.1097/CM9.0000000000000769
摘要
高流量鼻插管氧疗（HFNC）是一种新型的呼吸支持技术，近年来在临床上得到了广泛应用。这种治疗设备主要包括空气-氧气混合器、主动加湿器、高流量鼻插管和连接吸气回路。它为患者提供氧气浓度（21-100%）、温度（31-37℃）相对稳定的加湿高流量气体（8-80 L/min）并通过鼻插管进行氧疗，非常舒适。[
Review Article
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头颈部鳞状细胞癌的靶向分子成像：精准医疗的窗口Wu Jun, Yuan Ying, Tao Xiao-Feng
中华医学杂志英文版2020年 133卷 11期
DOI: 10.1097/CM9.0000000000000751
摘要
Tumor biomarkers play important roles in tumor growth, invasion, and metastasis. Imaging of specific biomarkers will help to understand different biological activities, thereby achieving precise medicine for each head and neck squamous cell carcinoma (HNSCC) patient. Here, we describe various molecular targets and molecular imaging modalities for HNSCC imaging. An extensive search was undertaken in the PubMed database with the keywords including "HNSCC," "molecular imaging," "biomarker," and "multimodal imaging." Imaging targets in HNSCC consist of the epidermal growth factor receptor, cluster of differentiation 44 variant 6 (CD44v6), and mesenchymal-epithelial transition factor and integrins. Targeted molecular imaging modalities in HNSCC include optical imaging, ultrasound, magnetic resonance imaging, positron emission tomography, and single-photon emission computed tomography. Making the most of each single imaging method, targeted multimodal imaging has a great potential in the accurate diagnosis and therapy of HNSCC. By visualizing tumor biomarkers at cellular and molecular levels in vivo, targeted molecular imaging can be used to identify specific genetic and metabolic aberrations, thereby accelerating personalized treatment development for HNSCC patients.
Meta Analysis
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改良的临床疗效幽门螺杆菌根除治疗幽门螺杆菌阴性胃粘膜相关淋巴组织淋巴瘤：一项荟萃分析Xie Ya-Lin, He Chun-Yan, Wei Si-Qi, Guan Wen-Ju, Jiang Zheng
中华医学杂志英文版2020年 133卷 11期
DOI: 10.1097/CM9.0000000000000813
摘要
Background:
Helicobacter pylori (HP) has been considered to be one of the primary causes of gastric mucosa-associated lymphoid tissue (MALT) lymphoma since 1993. Low-grade gastric MALT lymphoma with HP is widely treated with HP eradication therapy, according to each specific clinical situation. However, several studies and guidelines indicate that the modified HP eradication therapy is also valid for HP-negative gastric MALT lymphoma. The aim of this study was to perform a meta-analysis of the clinical efficacy of the modified HP eradication therapy for gastric MALT lymphoma without HP.
Methods:
We searched studies that reported the response rate of the modified HP eradication therapy regimen for gastric MALT lymphoma without HP by using PubMed, Medline, and Ebsco from January 1971 until February 2019. All statistical analyses were carried out using R 3.5.3 (Mathsoft Company, Cambridge, MA, USA). The pooled response rate was expressed as a decimal. The heterogeneity test was performed using the I-squared (I2) statistic.
Results:
A total of 14 studies were selected with a total of 148 patients with HP-negative gastric MALT lymphoma. The overall pooled response rate was 0.38 (95% confidence interval [CI]: 0.29-0.47). The combined estimate is I2 = 57% (P < 0.01). The study subjects were categorized by factors (area of patients). The pooled response rate of the sub-groups (Korea, Japan, China, and Western countries) was 0.63 (95% CI: 0.50-0.76), 0.16 (95% CI: 0.05-0.30), 0.38 (95% CI: 0.20-0.55), and 0.57 (95% CI: 0.08-1.00). The response rate showed that the modified HP eradication therapy was effective for patients with HP-negative gastric MALT lymphoma, especially in Korea and Western countries.
Conclusion:
Therefore, the modified HP eradication therapy can be considered an optional therapy for patients with low-grade HP-negative gastric MALT lymphoma. However, several limitations were revealed in the meta-analysis. Further systematic reviews and research are required.
Viewpoint
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《新型冠状病毒肺炎病诊疗方案（试行第七版）》解读Zhao Jing-Ya, Yan Jia-Yang, Qu Jie-Ming
中华医学杂志英文版2020年 133卷 11期
DOI: 10.1097/CM9.0000000000000866
摘要
自2019冠状病毒病（COVID-19）爆发以来，中华人民共和国国家卫生健康委员会发布了一系列及时更新的指南。《新型冠状病毒肺炎病诊疗方案（试行第七版）》于2020年3月3日公布，是在积累的临床经验和对疾病更深入的认识基础上发展而来的。[
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2019年冠状病毒病的潜在治疗方案：利用过去疫情的知识指导未来的治疗Lin John, Ouyang Jing, Peng Xiao-Rong, Isnard Stéphane, Fombuena Brandon, Routy Jean-Pierre, Chen Yao-Kai
中华医学杂志英文版2020年 133卷 11期
DOI: 10.1097/CM9.0000000000000816
摘要
2019年12月，武汉市首次报告了新型冠状病毒（2019新型冠状病毒）感染病例，称为2019冠状病毒病（COVID-19）。[
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高血压：微生物群靶向治疗Liu Yao, Zhang Fa-Ming, Hu Wen-Zhi
中华医学杂志英文版2020年 133卷 11期
DOI: 10.1097/CM9.0000000000000657
摘要
高血压作为最常见的心血管疾病（CVD），发病率很高。2015年，该疾病在全球影响了约11.3亿人口，在18岁以上的中国人中，其患病率超过27.9%。[
Clinical Observation
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系统管理双胎妊娠减少妊娠并发症Gao Li, Lyu Shu-Ping, Zhao Xin-Rong, Wu Yi, Hua Ren-Yi, Wang Shan, Zhang Yan, Wang Yan-Lin
中华医学杂志英文版2020年 133卷 11期
DOI: 10.1097/CM9.0000000000000808
摘要
近几十年来，双胎妊娠显著增加，主要是由于通过辅助生殖技术实现的此类妊娠的增长率。双胎妊娠与高婴儿发病率和死亡率相关。已经发现母体肥胖与先兆子痫和其他不良结局的风险增加显著相关。怀孕期间母亲体重增加可能对母亲和胎儿健康有重要影响。妊娠期体重增加过多（GWG）的妇女更有可能增加妊娠期糖尿病（GDM）、巨大儿、早产和胎儿生长受限的风险。与单胎一样，预计GDM在双胞胎的孕前肥胖母亲中也更常见。[
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中国线粒体三功能蛋白缺乏症神经肌病表型患者的多系统受累Wei Cui-Jie, Chang Xing-Zhi, Ge Lin, Fu Xiao-Na, Fan Yan-Bin, Liu Jie-Yu, Wang Shuang, Li Hai-Li, Yang Yan-Ling, Xiong Hui
中华医学杂志英文版2020年 133卷 11期
DOI: 10.1097/CM9.0000000000000805
摘要
线粒体三功能蛋白（MTP）是一种多酶复合物，催化长链脂肪酸的线粒体β-氧化的最后三个步骤。在结构上，MTP由四个α亚基和四个β亚基组成，它们由哈达基因（OMIM 600890）和哈德卜基因（OMIM 143450）。突变哈达或者哈德卜导致MTP活性不同程度的下降，进而导致三种类型的临床表现：新生儿发病的严重表型、婴儿发病的肝脏表型和晚发病的神经肌病表型。[
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分支优先孙氏手术：主动脉夹层和主动脉瘤患者的早期经验Zheng Jun, Liu Tong, Gao Hui-Qiang, Zhang You-Cong, Li Jian-Rong, Pan Xu-Dong, Sun Li-Zhong, Xu Shang-Dong
中华医学杂志英文版2020年 133卷 11期
DOI: 10.1097/CM9.0000000000000564
摘要
尽管在概念和手术技术方面取得了巨大进步，但对于大多数心脏手术中心来说，牙弓置换仍然是一个挑战。经典的Sun手术（使用带支架象鼻植入的四分支移植物进行全弓置换）在A型主动脉夹层病例的弓置换中取得了良好的效果，成为我中心A型主动脉夹层的标准治疗方法。[
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妊娠早期平均血小板体积作为妊娠期糖尿病的预测因子Ren Zhuo, Lin Li, Li Zhi, Sun Xin-Ping, Yang Kai, Yang Hui-Xia
中华医学杂志英文版2020年 133卷 11期
DOI: 10.1097/CM9.0000000000000825
摘要
妊娠期糖尿病（GDM）表现为妊娠期不同程度的碳水化合物不耐受。根据几项研究，GDM影响4%至25%的孕妇。大多数GDM患者存在不同程度的胰岛素抵抗和慢性低度炎症，这与血管损伤和功能障碍以及随后的血小板活化有关。[
Rapid Report
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聚集性过敏原免疫治疗引起的早期转录组谱变异Li Li-Sha, Zhang Hao, Wang Meng, Wang Xiu-Jie, Guan Kai
中华医学杂志英文版2020年 133卷 11期
DOI: 10.1097/CM9.0000000000000829
摘要
过敏原免疫疗法通过向患有过敏性疾病的患者重复施用特定的过敏原以防止过敏反应来执行。它是过敏性鼻炎和哮喘的唯一疾病缓解疗法，许多临床试验和荟萃分析都证明了其有益作用。[
Correspondence
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超声在预测成人患者困难喉镜检查中的应用Wan Lei, Xue Fu-Shan, Shao Liu-Jia-Zi, Yang He
中华医学杂志英文版2020年 133卷 11期
DOI: 10.1097/CM9.0000000000000789
摘要
致编辑：在一项前瞻性、自我对照、评估者盲法、观察性研究中，Wang等人[
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肌萎缩侧索硬化产妇剖宫产术的麻醉处理Li Jiao, Zeng Hong, Li Min, Wang Jun
中华医学杂志英文版2020年 133卷 11期
DOI: 10.1097/CM9.0000000000000809
摘要
致编辑：肌萎缩侧索硬化（ALS）是一种与上下运动神经元变性相关的无情进行性神经肌肉疾病。它最终导致肌肉无力、萎缩，并在3至5年内死亡，最常见的是呼吸衰竭。这些患者，尤其是产妇的适当麻醉管理给麻醉师带来了各种挑战。
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P45技术揭示人体脚踝中的弓箭征Jiang Wen-Bin, Li Chan, Sun Shi-Zhu, Chen Wei, Yu Sheng-Bo, Sui Hong-Jin
中华医学杂志英文版2020年 133卷 11期
DOI: 10.1097/CM9.0000000000000729
摘要
致编辑：最近的研究表明，骨的形态在体内，包括骨骼的形状、直径、长度、曲线和排列，适应骨骼成熟前后的长期负荷。根据应变的大小、作用方式、位置和应变的骨质量不同，变形和速率也不同，这被称为骨动态变形定律。[
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肺移植患者多粘菌素B相关呼吸骤停Chen Wen-Hui, Lin Lan, Wang Xiao-Xing, Kong Xu-Dong, Guo Li-Juan, Zhao Li, Liang Chao-Yang, Xing Bin, Cao Bin, Wang Chen 等
中华医学杂志英文版2020年 133卷 11期
DOI: 10.1097/CM9.0000000000000826
摘要
致编辑：多粘菌素抗生素粘菌素（多粘菌素E）和多粘菌素B（PMB）于20世纪50年代问世；因此，他们没有经历当代药物开发程序。它们的临床应用最近重新兴起，作为无法治疗的革兰氏阴性感染的挽救疗法发挥了重要作用。[
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改良注射技术提高瘢痕疙瘩治疗效果Xiao Hai-Tao, Deng Ke, Liu Xiao-Xue, Xu Xue-Wen, Zhang Yan-Ge
中华医学杂志英文版2020年 133卷 11期
DOI: 10.1097/CM9.0000000000000804
摘要
致编辑：瘢痕疙瘩是一种特殊类型的疤痕，超过原始伤口边界，不太可能自发收缩。已经报道了许多治疗瘢痕疙瘩的方法，包括手术切除、放射、注射、激光疗法和冷冻疗法。然而，没有一种方法可以确保完全治愈。在已报道的方法中，病灶内注射类固醇被广泛使用。大量研究表明，在瘢痕疙瘩内注射糖皮质激素联合5-氟尿嘧啶（5-FU），可软化瘢痕疙瘩质地，缩小体积，缓解相关症状。[
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双侧锁骨上动脉岛状皮瓣修复下咽及颈部皮肤缺损1例Zhou Jing, Ding Yi-Ming, Zhou Meng-Jiao, Kuang Yun-Xun, Ma Ting-Yao, Chen Xiao-Hong
中华医学杂志英文版2020年 133卷 11期
DOI: 10.1097/CM9.0000000000000831
摘要
致编辑：在晚期头颈部恶性肿瘤中，特别是经颈部手术或放疗史等综合治疗后复发的患者，肿瘤可同时侵犯粘膜和皮肤。肿瘤切除后形成的穿透性缺损的重建必须达到以下目的：（1）重建消化道，恢复吞咽功能。（2）为颈部重要结构的修复提供软组织，即重建颈部的皮肤。我们采用双侧锁骨上动脉岛状皮瓣修复1例喉恶性肿瘤晚期患者术后颈部大面积皮肤伴粘膜缺损，术后效果满意。
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颌骨孤立性环状斑块：二期梅毒的非典型表现Wu Juan, Chen Hao, Long Fu-Quan
中华医学杂志英文版2020年 133卷 11期
DOI: 10.1097/CM9.0000000000000807
摘要
致编辑：梅毒是一种由梅毒螺旋体（T.pallidum）继发性梅毒病变通常发生在初次暴露于T.苍白球二期梅毒最常见的皮肤表现是黄斑和丘疹。然而，其他不常见的病变，如结节性、脓疱性、弓形和银屑病样病变，偶尔也有报道。[
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高通量测序用于确认通过荧光定量聚合酶链反应鉴定的疑似2019新型冠状病毒感染Guan Wen-Da, Chen Li-Ping, Ye Feng, Ye Dan, Wu Shi-Guan, Zhou Hong-Xia, He Jia-Yang, Yang Chun-Guang, Zeng Zhi-Qi, Wang Yu-Tao 等
中华医学杂志英文版2020年 133卷 11期
DOI: 10.1097/CM9.0000000000000792
摘要
致编辑：从临床样本中识别病原体对于新出现的传染病的诊断至关重要，例如对全球公共卫生构成巨大威胁的2019年新型冠状病毒（2019新型冠状病毒）。[
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