MedNexus
2020年 · 第133卷第12期
出版日期 2020-06-20电子版 ￥0.00元
MedNexus
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- Consensus Statement
- Review Article
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Editorial
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2019冠状病毒病根除的可行性Zheng Ya-Li, He Yu-Kun, Ma Xin-Qian, Gao Zhan-Cheng
中华医学杂志英文版2020年 133卷 12期
DOI: 10.1097/CM9.0000000000000936
摘要
2020年3月11日，世界卫生组织宣布当前爆发的冠状病毒疾病2019（新冠肺炎）为全球疫情。[
Original Article
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肺移植作为冠状病毒疾病2019相关肺纤维化急性呼吸窘迫综合征的治疗选择Chen Jing-Yu, Qiao Kun, Liu Feng, Wu Bo, Xu Xin, Jiao Guo-Qing, Lu Rong-Guo, Li Hui-Xing, Zhao Jin, Huang Jian 等
中华医学杂志英文版2020年 133卷 12期
DOI: 10.1097/CM9.0000000000000839
摘要
Background:
Critical patients with the coronavirus disease 2019 (COVID-19), even those whose nucleic acid test results had turned negative and those receiving maximal medical support, have been noted to progress to irreversible fatal respiratory failure. Lung transplantation (LT) as the sole therapy for end-stage pulmonary fibrosis related to acute respiratory distress syndrome has been considered as the ultimate rescue therapy for these patients.
Methods:
From February 10 to March 10, 2020, three male patients were urgently assessed and listed for transplantation. After conducting a full ethical review and after obtaining assent from the family of the patients, we performed three LT procedures for COVID-19 patients with illness durations of more than one month and extremely high sequential organ failure assessment scores.
Results:
Two of the three recipients survived post-LT and started participating in a rehabilitation program. Pearls of the LT team collaboration and perioperative logistics were summarized and continually improved. The pathological results of the explanted lungs were concordant with the critical clinical manifestation, and provided insight towards better understanding of the disease. Government health affair systems, virology detection tools, and modern communication technology all play key roles towards the survival of the patients and their rehabilitation.
Conclusions:
LT can be performed in end-stage patients with respiratory failure due to COVID-19-related pulmonary fibrosis. If confirmed positive-turned-negative virology status without organ dysfunction that could contraindicate LT, LT provided the final option for these patients to avoid certain death, with proper protection of transplant surgeons and medical staffs. By ensuring instant seamless care for both patients and medical teams, the goal of reducing the mortality rate and salvaging the lives of patients with COVID-19 can be attained.
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持续强化治疗使用缓解疾病的抗风湿药物治疗类风湿性关节炎的效果：一项为期5年的真实世界连续研究Cai Yue-Ming, Li Ru, Ye Hua, He Jing, Sun Xiao-Lin, Jin Jia-Yang, Liu Jia-Jia, Gan Yu-Zhou, You Xu-Jie, Xu Jing 等
中华医学杂志英文版2020年 133卷 12期
DOI: 10.1097/CM9.0000000000000811
摘要
Background:
Intensive therapy with disease modifying anti-rheumatic drugs (DMARDs) has been reported to improve the outcomes of rheumatoid arthritis (RA). However, real-world study on the effect of intensive therapy on RA sustained remission is still lacking. This study aimed to investigate the outcome of sustained intensive DMARD therapy (SUIT) for RA in a real-world 5-year consecutive cohort.
Methods:
Based on a consecutive cohort of 610 out-patients with RA, remission of RA was assessed in 541 patients from 2012 to 2017, by dividing into SUIT, non-SUIT, and intermittent SUIT (Int-SUIT) groups. Changes in the disease activity scores were evaluated by 28-joint disease activity score based on erythrocyte sedimentation rate (DAS28-ESR), 28-joint disease activity score based on C-reactive protein (DAS28-CRP), and clinical deep remission criteria (CliDR). Cumulative remission rates between different groups were compared using Kaplan-Meier curves and predictive factors of sustained remission were identified by univariate and multivariate logistic regression analysis.
Results:
The remission rates of the SUIT group decreased from 12.0% (65/541) to 5.6% (20/359) based on DAS28-ESR, from 14.0% (76/541) to 7.2% (26/359) based on DAS28-CRP, and from 8.5% (46/541) to 3.1% (11/359) based on CliDR, respectively, with a gradually decreasing trend during the 5 years. The SUIT regimen led to a significantly higher cumulative remission rate than non-SUIT regimen based on DAS28-ESR (39.7% vs. 19.5%, P = 0.001), DAS28-CRP (42.0% vs. 19.6%, P = 0.001), and CliDR (24.5% vs. 8.7%, P = 0.001). The cumulative remission rates of patients treated with SUIT regimen were significantly higher than those treated with Int-SUIT regimen based on DAS28-ESR (39.7% vs. 25.7%, P = 0.043) and CliDR (24.5% vs. 14.2%, P = 0.047), but there was no significant difference between the two groups based on DAS28-CRP (42.0% vs. 27.4%, P = 0.066). Multivariate logistic regression analysis showed that the use of SUIT regimen was an independent favorable predictor according to different remission definitions (for DAS28-ESR: odds ratio [OR], 2.215, 95% confidence interval [CI]: 1.271-3.861, P = 0.005; for DAS28-CRP: OR, 1.520, 95% CI: 1.345-1.783, P = 0.002; for CliDR: OR, 1.525, 95% CI: 1.314-1.875, P= 0.013).
Conclusion:
Sustained intensive treatment of RA is an optimal strategy in daily practice and will lead to an increased remission rate.
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中国南京持续性植物状态量表的临床应用Wang Pei-Dong, Gao Li, Di Hai-Bo, Li Jing-Qi, Ni Ying-Ying, Wang De-Sheng, Ding Xin-Sheng
中华医学杂志英文版2020年 133卷 12期
DOI: 10.1097/CM9.0000000000000806
摘要
Background:
It is a challenge to characterize the consciousness level of patients with severe disturbance of consciousness and predict their prognosis effectively for Chinese doctors. We aimed to investigate the psychometric property and the diagnostic practicality of severe disturbance of consciousness by Chinese Nanjing persistent vegetative state scale (CNPVSS) which was first set up in 1996 and modified in 2001 and 2011.
Methods:
The concurrent validity, inter-rater consistency and diagnostic accuracy of CNPVSS and Chinese version of coma recovery scale-revised (CRS-R) were investigated by assessment of 380 patients with severe disorders of consciousness.
Results:
Total scores of the CNPVSS were correlated significantly with that of the CRS-R, indicating acceptable concurrent validity. Sub-scale analysis showed moderate to high inter-rater reliability and test-retest reliability. CNPVSS was superior to CRS-R on the diagnosis sensitivity. The CNPVSS was able to distinguish 65 patients in emergence from minimal consciousness state who were misclassified as in minimal consciousness state (MCS) by the CRS-R, and it could also distinguish two patients in MCS who were misclassified as in vegetative state by the CRS-R.
Conclusion:
The CNPVSS is an appropriate measurement and is sensitive to distinguish the MCS patients from the VS patients.
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健康体检者血清尿酸与甲状腺功能的关系Wang Xiao-Jun, Qian Xi-Wen, Zhang Xu, Han Li, Zheng Yu-Qi, Wu Tao, Qin Guo-You, Ye Zhi-Bin, Xiao Jing
中华医学杂志英文版2020年 133卷 12期
DOI: 10.1097/CM9.0000000000000840
摘要
Background:
The relationship of uric acid (UA) with the thyroid function among healthy individuals remains unclear. We aimed to examine the relationship between UA contents and thyroid hormone levels in healthy Chinese individuals.
Methods:
This was a cross-sectional study of 1186 Chinese adults (736 men and 450 women) who underwent a health check-up at the Huadong Hospital Affiliated to Fudan University (Shanghai, China) between January 1, 2010 and July 31, 2018. Clinical and thyroid hormone levels were compared in different UA groups (in male and menopause women groups, MG1: UA < 5 mg/dL; MG2: 5 mg/dL ≤ UA< 7 mg/dL; and MG3: UA ≥ 7 mg/dL; in female groups, FG1 to FG3 represent the UA levels of <4 mg/dL, 4 mg/dL ≤ UA< 6 mg/dL, and ≥6 mg/dL, respectively). In addition, natural cubic spline regression, together with Pearson correlation analysis, was performed in investigating the correlation of UA with thyroid hormones.
Results:
After adjusting for confounding factors, low levels of UA (for males, UA < 5.30 mg/dL; for females, UA < 4.05 mg/dL) were negatively correlated with free triiodothyronine (FT3) both in men and women. UA levels between 4.83 and 6.06 mg/dL may act to protect FT3 in women, while UA levels between 6.39 and 7.09 mg/dL may protect FT3 in men. FT3 levels of low-range UA group reduced compared with mid-range UA and the high-range UA groups in both men and women.
Conclusions:
Our results provide epidemiologic evidence to support the negative correlation between low UA contents and FT3 in the Chinese Han population, suggesting that the reduced UA contents may serve as the risk factor to predict poor thyroid function in Chinese individuals.
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全外显子组测序评价脑脊液中循环肿瘤DNA检测胶质母细胞瘤基因组改变Duan Hao, Hu Ji-Long, Chen Zheng-He, Li Jue-Hui, He Zhen-Qiang, Wang Zhen-Ning, Zhang Guan-Hua, Guo Xiao-Yu, Liang Lun, Mou Yong-Gao
中华医学杂志英文版2020年 133卷 12期
DOI: 10.1097/CM9.0000000000000843
摘要
Background:
Cerebrospinal fluid (CSF) has been demonstrated as a better source of circulating tumor DNA (ctDNA) than plasma for brain tumors. However, it is unclear whether whole exome sequencing (WES) is qualified for detection of ctDNA in CSF. The aim of this study was to determine if assessment of ctDNA in CSF by WES is a feasible approach to detect genomic alterations of glioblastoma.
Methods:
CSFs of ten glioblastoma patients were collected pre-operatively at the Department of Neurosurgery, Sun Yat-sen University Cancer Center. ctDNA in CSF and genome DNA in the resected tumor were extracted and subjected to WES. The identified glioblastoma-associated mutations from ctDNA in CSF and genome DNA in the resected tumor were compared.
Results:
Due to the ctDNA in CSF was unqualified for exome sequencing for one patient, nine patients were included into the final analysis. More glioblastoma-associated mutations tended to be detected in CSF compared with the corresponding tumor tissue samples (3.56 ± 0.75 vs. 2.22 ± 0.32, P = 0.097), while the statistical significance was limited by the small sample size. The average mutation frequencies were similar in CSF and tumor tissue samples (74.1% ± 6.0% vs. 73.8% ± 6.0%, P = 0.924). The R132H mutation of isocitrate dehydrogenase 1 and the G34V mutation of H3 histone, family 3A (H3F3A) which had been reported in the pathological diagnoses were also detected from ctDNA in CSF by WES. Patients who received temozolomide chemotherapy previously or those whose tumor involved subventricular zone tended to harbor more mutations in their CSF.
Conclusion:
Assessment of ctDNA in CSF by WES is a feasible approach to detect genomic alterations of glioblastoma, which may provide useful information for the decision of treatment strategy.
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房颤治疗的一站式策略：导管消融和左心耳封堵术在一次手术中联合应用的可行性和安全性Chen Mu, Wang Zhi-Quan, Wang Qun-Shan, Sun Jian, Zhang Peng-Pai, Feng Xiang-Fei, Li Wei, Yu Ying, Liu Bo, Mo Bin-Feng 等
中华医学杂志英文版2020年 133卷 12期
DOI: 10.1097/CM9.0000000000000855
摘要
Background:
Catheter ablation is effective in restoring sinus rhythm and left atrial appendage closure (LAAC) is increasingly used for stroke prevention in patients with atrial fibrillation (AF). We aimed to observe the feasibility and safety of performing AF ablation and LAAC in a single (one-stop) procedure.
Methods:
Consecutive AF patients who underwent the combined procedure of AF ablation and LAAC with WATCHMAN device between March 2017 and September 2018 were prospectively enrolled. Baseline and intra-procedural parameters were evaluated. Three-month and subsequent 1-year follow-up were performed in all and earlier-enrolled subjects, respectively.
Results:
A total of 178 AF patients (94 males, 68.9 ± 8.1 years) underwent the one-stop procedure with CHA2DS2-VASc score 3.3 ± 1.5 and HAS-BLED score 1.6 ± 1.0, respectively. Pulmonary vein isolation was achieved in all patients while additional linear ablation was applied if the operator deemed necessary, yielding immediate ablation success rate of 98.9% (176/178). In the subsequent LAAC, satisfactory seal (residual leak <5 mm) was achieved in all patients. One stroke and four cardiac perforations occurred peri-operatively. At 3-month follow-up, sinus rhythm and satisfactory seal were maintained in 153/178 (86.0%) and 178/178 (100%) patients, respectively. One stroke and one delayed cardiac tamponade occurred, while no device-related thrombus or device migration was observed. During the 1-year follow-up for the earlier enrolled subjects, 52/72 (72.2%) of the patients maintained sinus rhythm. There was no stroke or systemic embolism observed.
Conclusion:
Combining catheter ablation and LAAC in a single procedure can be successfully and safely performed in non-valvular AF patients of Chinese population.
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Thromboxane A2 receptor contributes to the activation of rat pancreatic stellate cells induced by 8-epi-prostaglandin F2αZhang Xiao-Li, Li Fei, Cui Ye-Qing, Liu Shuang, Sun Hai-Chen
中华医学杂志英文版2020年 133卷 12期
DOI: 10.1097/CM9.0000000000000838
摘要
Background:
Pancreatic stellate cells (PSCs) activation plays a critical role in the development of chronic pancreatitis. Previous studies confirmed that thromboxane A2 receptor (TxA2r) was overexpressed in activated PSCs in rats. The purpose of this study was to investigate the role of TxA2r in the activation of PSCs induced by 8-epi-prostaglandin F2α (8-epi-PGF2α).
Methods:
TxA2r expression in both quiescent and activated PSCs was detected by immunocytochemistry and immunoblot assay. Isolated PSCs were treated with 8-epi-PGF2α (10-6, 10-7, 10-8 mol/L) for 48 h, and SQ29548 (10-4, 10-6, and 10-7 mol/L), a TxA2r-specific antagonist, for 48 h, respectively, to identify the drug concentration with the best biological effect and the least cytotoxicity. Then isolated PSCs were treated with SQ29548 (10-4 mol/L) for 2 h, followed by 10-7 mol/L 8-epi-PGF2α for 48 h. Real-time polymerase chain reaction was performed to detect the messenger RNA (mRNA) levels of α-smooth muscle actin (α-SMA) and collagen I. Comparisons between the groups were performed using Student’s t test.
Results:
TxA2r was up-regulated in activated PSCs in vitro compared with quiescent PSCs (all P < 0.001). Compared with the control group, different concentrations of 8-epi-PGF2a significantly increased mRNA levels of α-SMA (10-6 mol/L: 2.23 ± 0.18 vs. 1.00 ± 0.07, t= 10.70, P < 0.001; 10-7 mol/L: 2.91 ± 0.29 vs. 1.01 ± 0.08, t= 10.83, P <0.001; 10-8 mol/L, 1.67 ± 0.07 vs. 1.00 ± 0.08, t= 11.40, P < 0.001) and collagen I (10-6 mol/L: 2.68 ± 0.09 vs. 1.00 ± 0.07, t = 24.94, P < 0.001; 10-7 mol/L: 2.12 ± 0.29 vs. 1.01 ± 0.12, t = 6.08, P < 0.001; 10-8 mol/L: 1.46 ± 0.15 vs. 1.00 ± 0.05, t = 4.93, P = 0.008). However, different concentrations of SQ29548 all significantly reduced the expression of collagen I (10-4 mol/L: 0.55 ± 0.07 vs. 1.00 ± 0.07, t = 10.47, P < 0.001; 10-6 mol/L: 0.56 ± 0.10 vs. 1.00 ± 0.07, t = 6.185, P < 0.001; 10-7 mol/L: 0.27 ± 0.04 vs. 1.00 ± 0.07, t= 15.41, P < 0.001) and α-SMA (10-4 mol/L: 0.06 ± 0.01 vs. 1.00 ± 0.11, t= 15.17, P < 0.001; 10-6 mol/L: 0.28 ± 0.03 vs. 1.00 ± 0.11, t= 11.29, P < 0.001; 10-7 mol/L: 0.14 ± 0.04 vs. 1.00 ± 0.11, t= 12.86, P < 0.001). After being treated with SQ29548 (10-4 mol/L) and then 8-epi-PGF2α (10-7 mol/L), the mRNA levels of a-SMA (0.20 ± 0.08 vs. 1.00 ± 0.00, t= 17.46, P < 0.001) and collagen I (0.69 ± 0.13 vs. 1.00 ± 0.00, t = 4.20, P = 0.014) in PSCs were significantly lower than those of the control group.
Conclusions:
The results show that 8-epi-PGF2α promoted PSCs activation, while SQ29548 inhibited PSCs activation induced by 8-epi-PGF2α. The result indicated that TxA2r plays an important role during PSC activation and collagen synthesis induced by 8-epi-PGF2αin vitro. This receptor may provide a potential target for more effective antioxidant therapy for pancreatic fibrosis.
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丹酚酸B降低白细胞介素-1 β诱导的小鼠结肠炎复发Feng Pan-Pan, Fang Xue-Sheng, Zhao Si-Hui, Fu Jun-Yan, Zhang Hui-Ting, Yi Yan-Lin, Li Chang-Yi, Jiang Chun-Ling, Chen Da-Peng
中华医学杂志英文版2020年 133卷 12期
DOI: 10.1097/CM9.0000000000000773
摘要
Background:
Degree of mucosal recovery is an important indicator for evaluating the therapeutic effects of drugs in treatment of inflammatory bowel disease (IBD). Increasing evidences has proved that tight junction (TJ) barrier dysfunction is one of the pathological mechanisms of IBD. The aim of this study was to observe whether enhancement of TJ can decrease colitis recurrence.
Methods:
Eighty C57BL/6 mice were randomly divided into four groups including normal group, colitis group, sulfasalazine (SASP) treated group, and traditional Chinese drug salvianolic acid B (Sal B) treated group. Colitis was established in mice by free drinking water containing dextran sulfate sodium, after treatments by SASP and Sal B, recombinant human interleukin-1β (IL-1β) was injected intraperitoneally to induce colitis recurrence.
Results:
Compared with sham control, cell apoptosis in colitis group was increased from 100.85 ± 3.46% to 162.89 ± 11.45% (P = 0.0038), and TJ dysfunction marker myosin light chain kinase (MLCK) was also significantly increased from 99.70 ± 9.29% to 296.23 ± 30.78% (P = 0.0025). The increased cell apoptosis was reversed by both SASP (125.99 ± 8.45% vs. 162.89 ± 11.45%, P = 0.0059) and Sal B (104.27 ± 6.09% vs. 162.89 ± 11.45%, P = 0.0044). High MLCK expression in colitis group was reversed by Sal B (182.44 ± 89.42% vs. 296.23 ± 30.78%, P = 0.0028) but not influenced by SASP (285.23 ± 41.04% vs. 296.23 ± 30.78%, P > 0.05). The recurrence rate induced by recombinant human IL-1β in Sal B-treated group was significantly lower than that in SASP-treated group.
Conclusions:
These results suggested a link between intestinal mucosal barrier dysfunction, especially TJ barrier dysfunction, and colitis recurrence. The TJ barrier dysfunction in remission stage of colitis increased the colitis recurrence. This study might provide potential treatment strategies for IBD recurrence.
Consensus Statement
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二甲双胍临床应用中国专家共识声明Expert Group of Metformin in Clinical Practice
中华医学杂志英文版2020年 133卷 12期
DOI: 10.1097/CM9.0000000000000883
摘要
二甲双胍是世界上使用最广泛的口服降糖药之一，几十年来在治疗2型糖尿病方面发挥着重要作用，因其对单药治疗和联合治疗具有良好的疗效和安全性，有健康经济效益的证据，在预防心血管并发症方面有明确的临床证据，已被世界各地糖尿病指南推荐为一线用药。
Review Article
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正电子发射计算机断层扫描/单光子发射计算机断层扫描在帕金森病中的应用Yao Nian-Ting, Zheng Qian, Xu Zi-Qian, Yin Jian-Hong, Lu Lin-Guang, Zuo Qi, Yang Su, Zhang Chun-Lin, Jiao Ling
中华医学杂志英文版2020年 133卷 12期
DOI: 10.1097/CM9.0000000000000836
摘要
Parkinson disease (PD) is the second-most common neurodegenerative disorder. Its main pathological mechanism is the selective degeneration and deletion of dopaminergic neurons in the dense part of the substantia nigra and the damage of dopaminergic neurons caused by the abnormal deposition of a Lewy body, leading to a decreased dopamine level. Positron emission computed tomography (PET)/single photon emission computed tomography (SPECT) is a molecular imaging technology that can directly or indirectly reflect changes in molecular levels by using a specific tracer. With the research and development on the tracers of related enzymes for labeling dopamine transporter and dopamine receptor and for being involved in dopamine formation, this imaging technology has been applied to all aspects of PD research. It not only contributes to clinical work but also provides an important theoretical basis for exploring the pathological mechanism of PD at a molecular level. Therefore, this review discusses the application value of PET/SPECT in PD in terms of early diagnosis, disease severity evaluation, clinical manifestations, differential diagnosis, and pathological mechanism.
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硬化素调节：通过调节牙槽骨治疗牙周炎的一种有前途的疗法Li Tian-Jiao, Wang Rui, Li Qin-Yang, Li Chun-Yu, Jiang Li
中华医学杂志英文版2020年 133卷 12期
DOI: 10.1097/CM9.0000000000000764
摘要
Periodontitis is one of the most prevalent epidemics affecting human health and life recently, and exploration of the pathogenesis and treatment of periodontitis has been valued by scholars. In recent years, sclerostin, a new factor on bone resorption and reconstruction caused by inflammation and mechanical stimulation, has been a research hotspot. This article summarizes the researches on sclerostin in periodontitis development in recent years. Among them, sclerostin has been shown to be a critical negative regulator of bone formation, thereby inhibiting bone remodeling in periodontitis development, and is closely associated with tooth movement. Besides, evidence indicates that the removal of sclerostin seems to reasonably protect the alveolar bone from resorption. Regulation of sclerostin expression is a novel, promising treatment for periodontitis and addresses several complications seen with traditional therapies; accordingly, many drugs with similar mechanisms have emerged. Moreover, the application prospect of sclerostin in periodontal therapy combined with orthodontic treatment is another promising approach. There are also a lot of drugs that regulate sclerostin. Anti-sclerostin antibody (Scl-Ab) is the most direct one that inhibits bone resorption caused by sclerostin. At present, drugs that inhibit the expression of sclerostin have been applied to the treatment of diseases such as multiple myeloma and osteoporosis. Therefore, the application of sclerostin in the oral field is just around the corner, which provides a new therapeutic bone regulation strategy in oral and general health.
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原发性中枢神经系统淋巴瘤：诊断、分子发病机制和治疗的现状和进展Zhang Yan, Zhou Dao-Bin
中华医学杂志英文版2020年 133卷 12期
DOI: 10.1097/CM9.0000000000000844
摘要
Primary central nervous system lymphoma (PCNSL) is a rare group of extra-nodal non-Hodgkin lymphoma which is confined to the central nervous system or eyes. This article aims to present a brief profile of PCNSL diagnosis and treatment in immunocompetent patients. The authors retrieved information from the PubMed database up to September 2019. The annual incidence of PCNSL increased over the last four decades. The prognosis of PCNSL has improved mainly due to the introduction and wide-spread use of high-dose methotrexate, which is now the backbone of all first-line treatment polychemotherapy regimens. Gene expression profiling and next-generation sequencing analyses have revealed mutations that induce activation of nuclear factor-κB, B cell antigen receptor, and Janus kinases/signal transducer and activator of transcription proteins signal pathways. Some novel agents are investigated in the treatment of relapsed PCNSL including immunotherapy and targeted therapy. In particular, lenalidomide and ibrutinib have demonstrated durable efficiency. Treatment of PCNSL has evolved in the last 40 years and survival outcomes have improved in most patient groups, but there is still room to improve outcome by optimizing current chemotherapy and novel agents.
Medical Progress
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特发性肺纤维化急性加重期患者的治疗现状Zhu Li-Li, Dai Hua-Ping, Wang Chen
中华医学杂志英文版2020年 133卷 12期
DOI: 10.1097/CM9.0000000000000864
摘要
特发性肺纤维化（IPF）是一种慢性、进行性且通常致命的纤维化肺部疾病，诊断后的中位生存期为2至3年。[
Clinical Observation
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基于肝脏供体的活体器官供体生活质量量表（QLSLOD-CM V1.0）通用模块的开发和心理测量学特性评估Shi Yue-Xian, Zhang Hai-Ming, Chen Jing, Li Hao-Hao, Yu Ming-Ming, Jin Yin-Hui, Huang Ya-Qi, Sun Meng, Gao Wei, Shang Shao-Mei
中华医学杂志英文版2020年 133卷 12期
DOI: 10.1097/CM9.0000000000000833
摘要
根据定义，活体捐赠者是没有重大医疗问题的健康人。然而，与捐献有关的程序使活体捐献者面临许多并发症的风险，捐献者的安全仍然是一个令人担忧的问题。[
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大剂量乌司他丁对体外循环心脏直视手术患者炎症反应的影响Liu Yu, Wang Ying-Lin, Zou Shao-Hua, Sun Peng-Fei, Zhao Quan
中华医学杂志英文版2020年 133卷 12期
DOI: 10.1097/CM9.0000000000000832
摘要
乌司他丁（UTI）是一种广谱弹性蛋白酶抑制剂，能稳定溶酶体膜，抑制体外循环（CPB）引起的多种炎性细胞因子的激活和释放。[
Correspondence
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2019年新型冠状病毒不同阶段感染者血清免疫球蛋白M和免疫球蛋白G抗体检测Gao Hui-Xia, Li Ya-Nan, Xu Zun-Gui, Wang Yu-Ling, Wang Hai-Bin, Cao Jin-Feng, Yuan De-Qin, Li Li, Xu Yi, Zhang Zhi 等
中华医学杂志英文版2020年 133卷 12期
DOI: 10.1097/CM9.0000000000000820
摘要
致编辑：2019新型冠状病毒（2019新型冠状病毒）引发的疫情引发舆论关注。[
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嗜铬细胞瘤相关可逆性肾梗死1例Liu Lu, Qiu Jian-Xing, Gao Ying, Tian Jie, Zhang Zheng, Zhang Jun-Qing, Guo Xiao-Hui
中华医学杂志英文版2020年 133卷 12期
DOI: 10.1097/CM9.0000000000000759
摘要
致编辑：勉强控制的高血压和儿茶酚胺的过量产生引起的嗜铬细胞瘤并发症可降低患者的预期寿命和生活质量。在此，我们报告了一例与嗜铬细胞瘤相关的计算机断层扫描（CT）双侧多发性肾梗死，在肿瘤切除后的随访中获得完全缓解。男，47岁，高血压未控制3年病史（记录的最高值为210/160mmHg），间歇性剧烈头痛、面色苍白、出汗于2014年4月15日到我院就诊。他没有定期监测血压，但偶尔服用二氢吡啶类钙通道阻滞剂。无肾脏疾病、血栓栓塞性疾病或肾动脉损伤史。入院时体检显示血压160/80 mmHg。他的心率为90次/分钟，呼吸频率为18次/分钟。尿液分析显示轻微血尿。注意到血清肌酐和血尿素氮短暂升高，在补液后2天内恢复正常。凝血酶原时间、活化部分凝血活酶时间和D-二聚体水平均在正常范围内【补充表1，http://links.lww.com/CM9/A206】，而血浆肾上腺素水平为7829.60（参考区间：9.16-254.60）pg/mL，去甲肾上腺素水平为6121.70（86.30-551.60）pg/mL。腹部CT显示右侧肾上腺有8.5 cm肿瘤，双侧肾脏多发性楔形灌注缺损[
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中国汉族人群富含亮氨酸重复激酶2变异体的帕金森病患者黑质高回声Li Kai, Gu Chen-Chen, Zhang Jin-Ru, Jin Hong, Ge Yi-Lun, Chen Jing, Yang Ya-Ping, Wang Fen, Mao Cheng-Jie, Zhang Ying-Chun 等
中华医学杂志英文版2020年 133卷 12期
DOI: 10.1097/CM9.0000000000000842
摘要
致编辑：帕金森病(PD)是第二常见的神经退行性疾病，其特征在于运动和非运动症状。富亮氨酸重复激酶2（LRRK2）基因，其特征在于不同人群中的不同突变，在家族性和散发性PD中都是众所周知的。G2019S突变的频率在德系犹太人和北非阿拉伯人人群中为20%至40%，而G2385R是与亚洲人群相关的常见风险因素。研究团队发现，G2385R在中国汉族人群中也与PD相关，表明该突变对汉族人群有明确的贡献，但对中国汉族人群中临床PD症状的描述很少，需要进一步的G2385R基因型-表型分析。PD患者的黑质（SN）高回声通过经颅超声（TCS）确定。它是PD的风险标志物，与白质的微结构改变相关，包括那些与运动和边缘功能相关的区域。既往研究LRRK2变异，尤其是G2019S突变，已经探索了高加索人之间的潜在关联LRRK2变异和SN高回声，[
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传染性胃肠炎的分子诊断实践Shen Nan, Tao Yue, Du Bai-Lu, Cao Qing
中华医学杂志英文版2020年 133卷 12期
DOI: 10.1097/CM9.0000000000000841
摘要
致编辑：腹泻疾病的特征是稀便、水样或频繁需要排便，感染性胃肠炎是世界范围内腹泻疾病的主要原因。尽管公共卫生和经济有所改善，但腹泻疾病仍然是一个主要的公共卫生问题，并带来相关的负担。[
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8天内两次核酸检测阴性的2019冠状病毒病1例Ruan Zhong-Rui, Gong Peng, Han Wei, Huang Min-Qiang, Han Ming
中华医学杂志英文版2020年 133卷 12期
DOI: 10.1097/CM9.0000000000000788
摘要
致编辑：迄今为止，2019冠状病毒病（COVID-19）已在全球蔓延。由于病毒的确切来源、感染后病毒脱落的时间以及病毒的繁殖仍未明确，因此在控制病毒传播和治疗感染方面仍存在很大挑战。感染病例的快速诊断和早期隔离对整体防控工作极为重要。[
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冠状病毒感染与凝血功能关系的研究进展Zou Hai, Xiong Wan-Feng
中华医学杂志英文版2020年 133卷 12期
DOI: 10.1097/CM9.0000000000000821
摘要
致编辑：据悉，入住重症监护室（ICU）的2019冠状病毒病（COVID-19）感染患者与未入住ICU的患者相比，凝血酶原时间更长，血浆D-二聚体水平更高。这表明这些患者发生血栓栓塞的风险较高。此外，ICU患者血浆肿瘤坏死因子-α（TNF-α）水平明显高于非ICU患者，所有感染患者血浆TNF-α水平、白细胞介素（IL）-1水平和IL-8水平均高于正常水平。[
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基于知识图谱的先天淋巴细胞进化路径与热点分析Liu Ying, Zeng Zuo-Jing, Peng Shun-Lin
中华医学杂志英文版2020年 133卷 12期
DOI: 10.1097/CM9.0000000000000834
摘要
致编辑：先天淋巴细胞（ILCs）是缺乏特异性抗原受体但仍产生有效细胞因子以匹配T辅助细胞亚群的淋巴细胞的异质性群体。[
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多发性骨髓瘤相关抗利尿激素分泌不当综合征1例Tang Ran, Zhang Jia-Jia, Zhong Yu-Ping
中华医学杂志英文版2020年 133卷 12期
DOI: 10.1097/CM9.0000000000000837
摘要
致编辑：低钠血症，定义为血清钠浓度<135 mmol/L，是临床上最常见的水电解质失衡。低钠血症可能是其他疾病（如心力衰竭、肾衰竭、肺炎）的并发症。低钠血症可分为三大类：低血容量性；正常血容量，高血容量。低钠血症的发病机制包括服用水丸（利尿剂）等药物和一些抗抑郁药和止痛药；心力衰竭和肾脏或肝脏疾病，慢性严重腹泻或呕吐。
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胆管癌表现为获得性血栓性血小板减少性紫癜，经去整合素和具有血小板反应蛋白1型基序的金属蛋白酶自身抗体阳性证实，成员13Li Yue-Ting, Du Han-Ze, Wang Chun-Yao, Zhu Tie-Nan, Pan Bo-Ju, Zhang Lu
中华医学杂志英文版2020年 133卷 12期
DOI: 10.1097/CM9.0000000000000727
摘要
致编辑：血栓性血小板减少性紫癜（TTP）是一种危及生命的血栓性微血管病（TMA），临床特征为严重血小板减少、微血管病性溶血性贫血和局部缺血/梗死症状，包括神经功能障碍和肾功能不全。[
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桡动脉闭塞后经尺骨入路重复经皮冠状动脉介入治疗的经验教训Bi Xi-Le, Wang Qing-Sheng
中华医学杂志英文版2020年 133卷 12期
DOI: 10.1097/CM9.0000000000000737
摘要
致编辑：2017年8月13日，一名80岁男性因持续20分钟的胸骨后疼痛到心内科就诊。我们回顾了患者的病史记录，其中包括两次使用6F鞘管（11cm长，Cordis Corporation，FL，USA）的经桡动脉途径介入治疗。2009年2月13日，患者出现急性下壁心肌梗死，经右桡动脉行经皮冠状动脉介入治疗（PCI）。2009年2月19日，患者接受了第二次介入治疗，也是通过右桡动脉入路，进行择期前降支PCI。患者在首次PCI后戒烟。在这次入院时，在第三次干预之前，患者有微弱的径向脉搏，但他的右手没有症状。反向Allen试验显示，当尺动脉受压时，他的手在6秒内毛细血管再充盈。然而，我们在穿刺桡动脉时有困难，我们选择使用右尺动脉入路进行心导管插入术。我们通过经尺骨入路成功地将两个支架植入患者的回旋动脉。干预后，进行了前臂动脉造影，我们惊讶地发现桡动脉闭塞（RAO）发生在桡动脉近端，而不是穿刺部位附近。此外，我们检测到尺动脉和骨间动脉对闭塞的桡动脉有良好的侧支供应[
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