MedNexus
2020年 · 第133卷第14期
出版日期 2020-07-20电子版 ￥0.00元
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Original Article
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恩替卡韦加聚乙二醇干扰素治疗在逆转初治慢性乙型肝炎患者肝纤维化中起积极作用：一项前瞻性随机对照试验Yang Jing-Mao, Chen Li-Ping, Wang Ya-Jie, Lyu Bei, Zhao Hong, Shang Zhi-Yin, Li Jun, Fan Zhen-Yu, Wu Sheng-Di, Ming Xiao 等
中华医学杂志英文版2020年 133卷 14期
DOI: 10.1097/CM9.0000000000000857
摘要
Background:
The efficacy of entecavir (ETV) add-on peg-interferon therapy compared with ETV monotherapy in treatment-naïve hepatitis B virus (HBV) patients remains controversial. We investigated whether adding peg-interferon to ongoing ETV treatment leads to a better curative effect or not.
Methods:
All patients have been recruited between August 2013 and January 2015 from the Shanghai Public Health Clinical Center and Zhongshan Hospital (China). Eligible HBV patients (n = 144) were randomly divided (1:1) to receive either ETV monotherapy (n = 70) or peg-interferon add-on therapy from week 26 to 52 (n = 74). Patients were followed-up for at least 2 years. Indexes including hepatitis B surface antigen (HBsAg) and hepatitis B e antigen (HBeAg) seroconversion rate, sustained virologic response, transient elastography value, and histological scores were evaluated every 3 months until the end of the study. The rate of patients with HBsAg loss was defined as the primary endpoint criteria.
Results:
At week 26, no patient achieved HBsAg seroconversion in either group. At week 52, one patient in the monotherapy group was HBsAg-negative but there was none in the combination therapy group. The monotherapy group showed significantly better liver function recovery results than the combination therapy group. At week 78, one patient in the combination group had HBsAg seroconverted. At week 104, only three patients in the combination therapy group were HBsAg-negative compared with one patient in monotherapy. The mean alanine aminotransferase and aspartate aminotransferase levels and transient elastography values decreased significantly compared with baseline. Both groups showed a favorable decrease in alpha-fetoprotein (monotherapy: 4.5 [2.8, 7.1] vs. 2.2 [1.8, 3.1] ng/mL, P < 0.001; combination therapy: 5.7 [3.0, 18.8] vs. 3.2 [2.0, 4.3] ng/mL, P < 0.001) and an improved result of liver biopsy examination scores. The combination group showed a better improvement in histology compared with the monotherapy group (mean transient elastography value 6.6 [4.9, 9.8] vs. 7.8 [5.4, 11.1] kPa, P = 0.028). But there was no significant difference in HBsAg conversion rate (1.8% [1/56] vs. 4.1% [3/73], P = 0.809) and HBeAg conversion rate (12.5% [7/56] vs. 11.0% [8/73], P = 0.787), as well as HBV-DNA, sustained virologic response (93.2% vs. 98.5%, P = 0.150) between the two groups.
Conclusions:
Both therapies supported liver function recovery and histology improvement. Combination therapy did not show better anti-viral efficacy in HBsAg or HBeAg seroconversion compared with monotherapy. However, combination therapy played a more positive role in reversing hepatic fibrosis compared with monotherapy.
Trial registration:
ClinicalTrials.gov: NCT02849132; https://clinicaltrials.gov/ct2/show/NCT02849132
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奥卡西平单药治疗伴有中央颞叶棘波的良性癫痫患儿可改善生活质量Liu Wan-Ting, Yan Xiu-Xian, Cheng Da-Zhi, Zhang Han-Zi, Ding Ning, Xu Ke-Ming, Zhou Xin-Lin, Chen Qian
中华医学杂志英文版2020年 133卷 14期
DOI: 10.1097/CM9.0000000000000925
摘要
Background:
Benign epilepsy with centrotemporal spikes (BECTS) is the most common type of childhood idiopathic focal epilepsy. BECTS is associated with pervasive cognitive deficits and behavior problems. While seizures can be easily controlled, it is crucial to select anti-epileptic drugs that do not impair cognition, do not cause psychosocial effects, and improve the quality of life. Previous studies showed effects of oxcarbazepine (OXC) monotherapy on the cognitive and psychosocial profiles of patients with BECTS. Here, we studied the effects of OXC monotherapy on the neuropsychologic profiles and quality of life in patients with BECTS in China.
Methods:
Thirty-one patients aged 6 to 12 years newly diagnosed with BECTS were recruited. A psychometric assessment was performed before and during the follow-up of OXC monotherapy with Cognitive Computerized Task Battery, Depression Self-Rating Scale for children, Screen for Child Anxiety Related Emotional Disorders, and Quality of Life in Epilepsy-31 (QOLIE-31). The results of the assessments were compared to explore the effect of OXC monotherapy in patients with BECTS.
Results:
Thirty children with BECTS completed the study. Five of ten cognitive test scores improved after treatment via OXC monotherapy, including visual tracing (F = 14.480, P < 0.001), paired associated learning (language) (F = 6.292, P < 0.001), paired associated learning (number) (F= 9.721, P < 0.05), word semantic (F = 6.003, P < 0.05), and simple subtraction (F = 6.229, P < 0.05). Of the neuropsychology data concerning the quality of life, statistically significant improvements were observed in emotion (F = 4.946, P < 0.05), QOLIE-social (F = 5.912, P < 0.05), and QOLIE-total (F= 14.161, P < 0.001).
Conclusions:
OXC is safe and does not impair neuropsychologic functions, with no obvious mood burden on children with BECTS. Most importantly, OXC has positive impacts on children’s perception of quality of life, especially in terms of happiness and life satisfaction.
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经颅多普勒预测前循环缺血性卒中血管内治疗成功后的早期神经功能恶化He Yan-Bo, Su Ying-Ying, Rajah Gary B., Zhang Ying-Bo, Fan Lin-Lin, Liu Gang, Chen Hong-Bo
中华医学杂志英文版2020年 133卷 14期
DOI: 10.1097/CM9.0000000000000881
摘要
Background:
Early neurologic deterioration (END) may occur in patients with anterior circulation ischemic stroke (ACIS) after receiving endovascular treatment (EVT). Hemodynamic insufficiency, re-occlusion, and post-re-canalization hyper-perfusion are likely to play a critical role in END. We hypothesized that hemodynamic changes can predict END in patients with ACIS post-successful EVT using trans-cranial Doppler (TCD).
Methods:
We utilized a prospectively maintained database of ACIS patients treated with EVT between September 2016 and June 2018 in the Xuanwu Hospital, Capital Medical University. TCD parameters including peak systolic velocity (PSV), bilateral mean flow velocity (MFV), and pulse index (PI) were determined via the middle cerebral arteries within 72 h post-EVT. A logistic regression model was applied to detect independent predictors for END.
Results:
Totally, 112 EVT patients were included in this study and 80/112 patients experienced successful re-canalization with <50% residual stenosis, while 17/80 (21.3%) patients suffered END, for which vasogenic cerebral edema (11/17) was considered as a leading role and followed by symptomatic intra-cranial hemorrhage (4/17) and ischemia progression (2/17). For the 80 patients, the PSV (median: 127 cm/s vs. 116 cm/s, P = 0.039), the ratio of ipsilateral-MFV/contra-lateral-MFV (iMFV/cMFV) (median: 1.29 vs. 1.02, P = 0.036) and iMFV/mean blood pressure (MBP) (median: 0.97 vs. 0.79, P = 0.008) in END patients were higher than those of non-END. Using the receiver-operating characteristic curve to obtain cut-off values for PSV, PI, iMFV/cMFV, and iMFV/MBP for END, we found that PI ≥0.85 (odds ratio: 11.03, 95% confidence interval: 1.92-63.46, P = 0.007) and iMFV/MBP ≥0.84 (odds ratio: 9.20, 95% confidence interval: 2.07-40.84, P = 0.004) were independent predictors of END in a multivariate logistic regression model, with a sensitivity of 82.4% and 76.5% and a specificity of 42.9% and 66.7%, respectively, and had the positive predictive values of 29.0% and 38.2%, and negative predictive values of 90.0% and 91.3%, with an area under the receiver-operating characteristic curve of 0.57 and 0.71, respectively.
Conclusion:
TCD examination of EVT patients may be used as a real-time tool to detect END predictors, such as the higher PI and iMFV/MBP, allowing for better post-thrombectomy management in ACIS patients.
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在无阻塞性冠状动脉疾病的心绞痛患者中，较高的血清血管生成素2水平与冠状动脉微血管功能障碍独立相关Chen Shao-Min, Li Dan, Xing Xing, Li Zhao-Ping
中华医学杂志英文版2020年 133卷 14期
DOI: 10.1097/CM9.0000000000000812
摘要
Background:
Angiopoietin-2 (Ang-2) is a type of endothelial growth factor involved in angiogenesis and vascular remodeling. Circulating Ang-2 levels are elevated in patients with obstructive coronary artery disease (CAD). This study aimed to evaluate the association between serum Ang-2 levels and coronary microvascular dysfunction in patients without obstructive CAD.
Methods:
A total of 125 patients with angina in the absence of obstructive CAD were included in this cross-sectional study. Coronary flow reserve (CFR) was measured in the distal left anterior descending coronary artery by trans-thoracic Doppler echocardiography. The patients were divided into the following two sub-groups according to CFR: the impaired CFR group with CFR values <2.5 and the preserved CFR group with CFR values ≥2.5. Serum Ang-2 levels were determined using enzyme-linked immunosorbent assay. Independent predictors for impaired CFR were identified by binary logistic regression analysis. The receiver-operating characteristic curve was determined to evaluate the ability of serum Ang-2 in predicting impaired CFR.
Results:
We found that age, percentage of female sex, N-terminal pro-B-type natriuretic peptide levels, Ang-2 levels (763.3 ± 264.9 vs. 579.7 ± 169.3 pg/mL, P < 0.001), and the left atrial volume index were significantly higher in patients with impaired CFR than in patients with preserved CFR. Serum Ang-2 levels were negatively correlated with CFR (r = -0.386, P < 0.001). Binary logistic regression analysis showed that Ang-2 (odds ratio: 1.004, 95% confidence interval [CI]: 1.001-1.006, P = 0.003) and age (odds ratio: 1.088, 95% CI: 1.023-1.156, P = 0.007) were independently associated with impaired CFR. Furthermore, Ang-2 was a significant predictor of impaired CFR on the receiver-operating characteristic curve (P < 0.001). The area under the curve was 0.712 (95% CI: 0.612-0.813).
Conclusions:
High serum Ang-2 levels are independently associated with impaired CFR in patients with angina in the absence of obstructive CAD.
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多层螺旋CT评价血友病性关节病Zhang Yu-Xia, Li Mei-Xia, Wei Shu-Fang, Zhang Lu, Cheng Tian-Ming, Ge Ying-Hui
中华医学杂志英文版2020年 133卷 14期
DOI: 10.1097/CM9.0000000000000876
摘要
Background:
Certain hemophilia patients are unable to cooperate with or afford magnetic resonance imaging (MRI) examinations. The purpose of our study was to explore the value of multislice spiral computed tomography (MSCT) in evaluating hemophilic arthropathy (HA).
Methods:
Thirty-eight patients with 73 joints of HA were consecutively selected from January 2016 to May 2018 for this prospective study. All 73 joints were examined by X-ray, CT, and MRI within 2 days. The MRI scores of the joints were determined by the International Prophylaxis Study Group (IPSG) standard. The CT findings were quantified according to the IPSG standard, except for cartilage injury, which was quantified by joint space narrowing using the X-ray Pettersson score. The CT and MRI scores were compared by the paired Wilcoxon signed-rank test. The correlations between the CT score of joint space narrowing and MRI score of cartilage injury and the total CT and MRI scores were analyzed by Spearman rank correlation. The kappa test was used to compare the consistency of CT and MRI scores.
Results:
MRI was superior to CT based on the scores for small amount of effusion (P < 0.05), synovial hypertrophy and hemosiderin deposition in the mild groups (P < 0.05). The CT and MRI scores were not significantly different for moderate and massive effusion, synovial hypertrophy, and hemosiderin deposition in the moderate and severe groups, bone erosion or cystic changes (P > 0.05), and there was a high degree of consistency between the two scores (kappa > 0.81). The consistency between the Pettersson scores of joint space narrowing on CT and the IPSG scores of cartilage injury on MRI was high (kappa = 0. 774, P < 0.05).
Conclusion:
The image scores of MSCT are generally consistent with MRI except for mild synovitis, which can be used as an alternative for the evaluation of HA.
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尸体前交叉韧带重建模型膝关节屈伸运动后环的变化Wang Jian, Yuan Fu-Zhen, Yu Jia-Kuo
中华医学杂志英文版2020年 133卷 14期
DOI: 10.1097/CM9.0000000000000907
摘要
Background:
Recently, adjustable-loop devices (ALDs) have been widely used, and their reliability has always been the focus of attention. This study compared loop length changes under pull stress caused by flexion and extension of the cadaver knee between ALDs and fixed-loop devices (FLDs) in terms of femoral fixation after anterior cruciate ligament (ACL) reconstruction.
Methods:
ACL reconstruction in cadaveric knee joints was performed under arthroscopy with femoral suspension devices and tibial fixation by tying sutures on staples. The knee joint was repeatedly flexed and extended 30 times after fixation. According to the femoral fixation device used (Endobutton or Ultrabutton), the knee joints were divided into two groups: the ALD group (12 specimens) and the FLD group (ten specimens). The length of the loop before and after fixation was measured, and the loop length of the ALD group was re-measured 1 day after reconstruction.
Results:
There was no significant difference in the length of the loop between the two groups (t = 0.579, P = 0.569). One day later, the loop length of the ALDs retracted by 0.29 ± 0.33 (0-1.1) mm, and there was no retraction in three specimens.
Conclusion:
There was no significant difference in the loop length under flexion and extension stress after ACL reconstruction between ALDs and FLDs.
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猪右心室流出道消融术中导管—组织接触力对病变大小的影响Jiang Jing-Bo, Li Jin-Yi, Jiang Zhi-Yuan, Wang An, Huang Zheng, Xu Hong-Yuan, Shu Cheng-Lin, Li Gui-Juan, Zheng Yi-Sheng, He Yan 等
中华医学杂志英文版2020年 133卷 14期
DOI: 10.1097/CM9.0000000000000859
摘要
Background:
The catheter-tissue contact force (CF) is one of the significant determinants of lesion size and thus has a considerable impact on the effectiveness of ablation procedures. This study aimed to evaluate the impact of CF on the lesion size during right ventricular outflow tract (RVOT) ablation in a swine model.
Methods:
Twelve Guangxi Bama miniature male pigs weighing 40 to 50 kg were studied. After general anesthesia, a ThermoCool SmartTouch contact-sensing ablation catheter was introduced to the RVOT via the femoral vein under the guidance of the CARTO 3 system. The local ventricular voltage amplitude and impedance were measured using different CF levels. We randomly divided the animals into the following four groups according to the different CF levels: group A (3-9 g); group B (10-19 g); group C (20-29 g); and group D (30-39 g). Radiofrequency ablations were performed at three points in the free wall and septum of the RVOT in power control mode at 30 W for 30 s while maintaining the saline irrigation rate at 17 mL/min. At the end of the procedures, the maximum depth, surface diameter, and lesion volume were measured and recorded. A linear regression analysis was performed to determine the relationship between continuous variables.
Results:
A total of 72 ablation lesions were created in the RVOT of the 12 Bama pigs. The maximum depth, surface diameter, and volume of the lesions measured were well correlated with the CF (free wall: β = 0.105, β = 0.162, β = 3.355, respectively, P < 0.001; septum: β = 0.093, β = 0.150, β = 3.712, respectively, P < 0.001). The regional ventricular bipolar voltage amplitude, unipolar voltage amplitude, and impedance were weakly positively associated with the CF (β = 0.065, β = 0.125, and β = 1.054, respectively, P < 0.001). There was a significant difference in the incidence of steam pops among groups A, B, C, and D (free wall: F = 7.3, P = 0.032; septum: F = 10.5, P = 0.009); and steam pops occurred only when the CF exceeded 20 g. Trans-mural lesions were observed when the CF exceeded 10 g in the free wall, while the lesions in the septum were non-trans-mural even though the CF reached 30 g.
Conclusions:
CF seems to be a leading predictive factor for the size of formed lesions in RVOT ablation. Maintaining the CF value between 3 and 10 g may be reasonable and effective for creating the necessary lesion size and reducing the risk of complications, such as steam pops and perforations.
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含锌指和BTB结构域的蛋白46对急性髓系白血病细胞系的存活和增殖是必需的，但对正常造血是不可或缺的Liu Yuan-Yuan, Xiao Fei-Fei, Yang Bi-Jie, Li Xi, Xu Shuang-Nian, Chen Zhi-Wei, Li Ping, Huang Yong-Xiu, Fu Xue-Mei, Huang Xing-Qin 等
中华医学杂志英文版2020年 133卷 14期
DOI: 10.1097/CM9.0000000000000878
摘要
Background:
Zinc finger and BTB domain-containing protein 46 (Zbtb46) is a transcription factor identified in classical dendritic cells, and maintains dendritic cell quiescence in a steady state. Zbtb46 has been reported to be a negative indicator of acute myeloid leukemia (AML). We found that Zbtb46 was expressed at a relatively higher level in hematopoietic stem and progenitor cells (HSPCs) compared to mature cells, and higher in AML cells compared to normal bone marrow (BM) cells. However, the role of Zbtb46 in HSPCs and AML cells remains unclear. Therefore, we sought to elucidate the effect of Zbtb46 in normal hematopoiesis and AML cells.
Methods:
We generated Zbtb46fl/fl and Zbtb46fl/flMx1-Cre mice. The deletion of Zbtb46 in Zbtb46fl/flMx1-Cre mice was induced by intraperitoneal injection of double-stranded poly (I). poly (C) (poly(I:C)), and referred as Zbtb46 cKO. After confirming the deletion of Zbtb46, the frequency and numbers of HSPCs and mature blood cells were analyzed by flow cytometry. Serial intraperitoneal injection of 5-fluorouracil was administrated to determine the repopulation ability of HSCs from Zbtb46fl/fl and Zbtb46 cKO mice. The correlation between Zbtb46 expression and prognosis was analyzed using the data from the Cancer Genome Atlas. To investigate the role of Zbtb46 in AML cells, we knocked down the expression of Zbtb46 in THP-1 cells using lentiviral vectors expressing small hairpin RNAs targeting Zbtb46. Cell proliferation rate was determined by cell count assay. Cell apoptosis and bromodeoxyuridine incorporation were determined by flow cytometry.
Results:
The percentages and absolute numbers of HSPCs and mature blood cells were comparable in Zbtb46 cKO mice and its Zbtb46fl/fl littermates (Zbtb46fl/flvs. Zbtb46 cKO, HPC: 801,310 ± 84,282 vs. 907,202 ± 97,403, t = 0.82, P = 0.46; LSK: 86,895 ± 7802 vs. 102,210 ± 5025, t = 1.65, P = 0.17; HSC: 19,753 ± 3116 vs. 17,608 ± 3508, t = 0.46, P = 0.67). The repopulation ability of HSCs from Zbtb46fl/flMx1-Cre mice was similar to those from Zbtb46fl/fl control (P = 0.26). Zbtb46 had elevated expression in AML cells compared to total BM cells from normal control. Knockdown of Zbtb46 in THP-1 cells led to a significant increase in cell apoptosis and reduced cell growth and proliferation.
Conclusion:
Collectively, our data indicate that Zbtb46 is essential for survival and proliferation of AML cells, but dispensable for normal hematopoiesis.
Review Article
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肝纤维化消退：证据与挑战Sun Ya-Meng, Chen Shu-Yan, You Hong
中华医学杂志英文版2020年 133卷 14期
DOI: 10.1097/CM9.0000000000000835
摘要
It has been reported that liver fibrosis could be reversed after eliminating liver injuries. This article systematically summarizes the evidence of fibrosis regression based on histology, liver stiffness, and serum biomarkers, and discusses several clinically relevant challenges. Evidence from liver biopsy has been regarded as the gold standard in the assessment of fibrosis regression. Semi-quantitative staging and grading systems are traditionally and routinely used to define regression. Recently, the predominantly regressive, indeterminate, and predominantly progressive score was proposed, based on the regressive features from "hepatic repair complex" , to provide additional information regarding the quality of fibrosis. For non-invasive assessment, although liver stiffness and serum biomarkers could be applied to reflect the dynamic changes of liver fibrosis, other confounding factors such as liver inflammation have to be considered. In conclusion, both histology and non-invasive methods can provide evidence regarding fibrosis regression. The predictive value of fibrosis regression in long-term prognosis warrants further investigation.
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子宫内膜异位症模型的建立：过去与未来Gu Zhi-Yue, Jia Shuang-Zheng, Leng Jin-Hua
中华医学杂志英文版2020年 133卷 14期
DOI: 10.1097/CM9.0000000000000885
摘要
Endometriosis is a prevalent chronic disease that affects approximately 6% to 10% of reproductive-aged women. Although numerous researchers have endeavored to explore the etiology of endometriosis over a century, its etiology still remains an enigma. The exploration of pathophysiologic mechanism and novel therapy for endometriosis depends on ideal endometriotic models. In the previous decade, various endometriotic models have been established; therefore, we made a conclusion for available information on these models. This review summarized the common experimental models used in endometriotic studies, including their origins, characteristics, applications, and limitations. Endometriotic models played an important role in studying etiologies and novel treatments of endometriosis during the last decades. Among them, animal models and endometriotic cell lines were viewed as most common studying tools to explore the intrinsic entities of endometriosis. In addition, endometrial organoid also emerged and was regarded as an ideal studying tool for endometriosis research. Different research models collectively complement each other to advance the endometriosis research. The successful establishment of endometrial organoids means that organoids are expected to become an ideal model for studying endometriosis in the future.
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卵泡膜细胞从何而来：卵泡膜细胞的衍生和分化机制Liu Tao, Qin Qing-Yuan, Qu Jiang-Xue, Wang Hai-Yan, Yan Jie
中华医学杂志英文版2020年 133卷 14期
DOI: 10.1097/CM9.0000000000000850
摘要
Mammalian follicles are composed of oocytes, granulosa cells, and theca cells. Theca cells form in the secondary follicles, maintaining follicular structural integrity and secreting steroid hormones. Two main sources of theca cells exist: Wilms tumor 1 positive (Wt1+) cells native to the ovary and Gli1+ mesenchymal cells migrated from the mesonephros. Normal folliculogenesis is a process where oocytes, granulosa cells, and theca cells constantly interact with and support each other through autocrine and paracrine mechanisms. The proliferation and differentiation of theca cells are regulated by oocyte-derived factors, including growth development factor 9 and bone morphogenetic protein 15, and granulosa cell-derived factors, including desert hedgehog, Indian hedgehog, kit ligand, insulin-like growth factor 1, as well as hormones such as insulin and growth hormones. Current research on the origin of theca cells is limited. Identifying the origin of theca cells will help us to systematically elaborate the mechanisms of follicular formation and development.
Viewpoint
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中国羊水栓塞诊断与处理专家共识解读Feng Ye, Yang Hui-Xia
中华医学杂志英文版2020年 133卷 14期
DOI: 10.1097/CM9.0000000000000886
摘要
羊水栓塞（AFE）是一种罕见但可能致命的疾病，其特征是突然发作、不可预测和高死亡率。母胎医学学会（SMFM）于2016年发布了第9号临床指南《羊水栓塞：诊断和管理》。[
Clinical Observation
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经济状况与收缩压或舒张压相关性的性别差异Li Jun, Feng Rui-Hua, Mao Yan-Na, Wang Xiao-Wan
中华医学杂志英文版2020年 133卷 14期
DOI: 10.1097/CM9.0000000000000953
摘要
高血压是心血管疾病的重要原因。如果控制不力，高血压会导致心脏病和中风，它们共同构成了全球过早死亡和残疾的主要原因。根据中国一项全国性横断面调查，2015年≥18岁成年人高血压患病率为23.2%。[
Correspondence
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携带间变性淋巴瘤激酶或ROS1重排的肺腺癌同侧乳腺转移及靶向治疗后显著反应：2例报告Zheng Jing, Zhou Jian-Ya, Bao Zhang, Shen Qian, Cao He, Zhou Jian-Ying
中华医学杂志英文版2020年 133卷 14期
DOI: 10.1097/CM9.0000000000000890
摘要
致编辑：患者女，43岁，因阵发性咳嗽6个月于2013年7月入住我科。她在其他医院被诊断为右下肺腺癌（cT2aN3M1b，IV期，间变性淋巴瘤激酶[ALK]+）伴骨转移，前来参加克唑替尼III期试验（编号NCT01639001）。
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免疫功能正常成人单纯疱疹病毒相关脓毒症：下一代测序的价值Li Shan, Jiang Wei, Peng Jin-Min, Du Bin, Weng Li
中华医学杂志英文版2020年 133卷 14期
DOI: 10.1097/CM9.0000000000000893
摘要
致编辑：一名先前健康的33岁中国男性最初因发热、上腹痛、呕吐和腹泻到当地医院就诊，持续5天。当地医疗中心的实验室检查结果显示肝肾功能受损。患者因疑似细菌感染和无尿而接受治疗。在患病第8天，患者变得困惑和迷失方向。他被转移到我们的急诊室。初步调查显示转氨酶严重升高和中度凝血病[
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第3天胚胎的延长培养提高了活产率体外受精-胚胎移植Zhao Xiao-Peng, Wang Ling, Ma Lu, Zuo Di, Chang Fei, Zhang Li-Yuan, Jia Jun-Long, Mo Shao-Kang, Sang Yuan-Kun, Ma Bin-Bin 等
中华医学杂志英文版2020年 133卷 14期
DOI: 10.1097/CM9.0000000000000901
摘要
致编辑：卵裂早期的胚胎发育是一个复杂且精心策划的生物过程。期间体外受精-胚胎移植（IVF-ET），胚胎按形态学标准常规分层，受精后第3天早晨移植。胚胎发育的这一阶段主要受母体因素调控，因为胚胎基因组尚未完全激活。[
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肌醇1, 4, 5-三磷酸受体依赖性钙的作用2+房颤释放Han Lu, Xia Zi-Rong, Li Ju-Xiang
中华医学杂志英文版2020年 133卷 14期
DOI: 10.1097/CM9.0000000000000898
摘要
致编辑：心肌电重构和结构重构与心房颤动(AF)的发病机制密切相关，心房颤动主要由Ca紊乱引起2+心房的稳态。最近的证据表明，肌醇1，4，5-三磷酸受体改变3R)活动可影响窦房结的传导速度和节律。Ca的破坏2+IP介导的体内平衡3Rs与房颤中观察到的特殊病理生理学密切相关，包括心房重构、炎症和氧化应激（OS）。
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热带地区成人恶性血液病和医院感染的病原体特征Dou Li-Ping, Hou Cheng, Yang Ting, Cheng Long-Can, Bo Jian
中华医学杂志英文版2020年 133卷 14期
DOI: 10.1097/CM9.0000000000000939
摘要
致编辑：人类病原体经过长时间进化成为嗜温菌，以适应人体典型的37℃温度。酵母和酵母样真菌在这个温度下也生长得很好，而丝状真菌生长的最佳温度是25~28℃。中国海南岛属热带海洋性季风气候，四季分明。此地多年平均气温为24.4℃，年气温变化较小；降水量约1718.6毫米，相对湿度82%。这些独特的天气特征为病原体提供了有利的生长环境。恶性血液病患者免疫力差，易受病原体感染。这导致恶性血液病患者的高医院感染率和频繁使用抗生素。不同地区和医院的流行病学调查可以为血液科医生治疗恶性血液病患者感染的临床用药提供更多指导。
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运动对改善非透析慢性肾脏病患者生活质量的疗效观察Ma Deng-Yan, Chen Chong-Cheng, Diao Yong-Shu, Yang Kun, Li Yi, Salerno Steve, Fu Ping
中华医学杂志英文版2020年 133卷 14期
DOI: 10.1097/CM9.0000000000000941
摘要
致编辑：慢性肾脏疾病（CKD）正迅速成为主要的公共疾病负担，影响约11%至13%的普通人群。[
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膝关节骨性关节炎患者定量磁共振成像与临床症状的关系Wang Xin-Guang, Gao Li-Xiang, Zhao Min-Wei, Geng Xiao, Wu Tian-Chen, Yuan Hui-Shu, Tian Hua
中华医学杂志英文版2020年 133卷 14期
DOI: 10.1097/CM9.0000000000000879
摘要
致编辑：定量磁共振成像（MRI）通过测定蛋白聚糖、胶原纤维和含水量的变化，客观评价膝骨关节炎（KOA）患者软骨的退变情况，从而便于临床早期诊断和治疗。[
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健康儿童慢性双侧髌骨袖状骨折1例Shao Jia-Yi, Yang Yu-Ping, Ao Ying-Fang
中华医学杂志英文版2020年 133卷 14期
DOI: 10.1097/CM9.0000000000000926
摘要
致编辑：髌骨袖状骨折被认为是儿科人群中一种独特类型的髌骨损伤。它是一种特殊类型的撕脱骨折，其中撕脱碎片由来自髌骨的小骨碎片组成，伴有大部分关节软骨。[
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脂质体两性霉素B联合泊沙康唑成功治疗肺毛霉菌病播散的皮肤毛霉菌病Ding Xiao-Lan, Li Hou-Min, Du Juan
中华医学杂志英文版2020年 133卷 14期
DOI: 10.1097/CM9.0000000000000891
摘要
致编辑：患者男，52岁，发热，右大腿疼痛溃疡10天。患者急性淋巴细胞白血病2年。2个月前，患者出现咳嗽、咳痰。血液和肺组织培养结果为阴性，但血清1，3-β-D-葡聚糖测定为阳性。胸部计算机断层扫描（CT）显示右肺有新的渗出。诊断为肺部真菌感染。十天前，患者开始发烧，同时注意到右大腿上有一个小红斑，并伴有剧烈疼痛。病灶迅速扩大，中央变成溃疡。查体示右大腿溃疡2cm × 4cm，周围有红斑、硬结，溃疡上可见坏死焦痂，无脓性分泌物渗出[
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人体皮肤对金属排斥反应的定性研究Lyu Wen-Tian
中华医学杂志英文版2020年 133卷 14期
DOI: 10.1097/CM9.0000000000000865
摘要
致编辑：人体皮肤不仅是防止外来物质侵入的物理屏障，也是对病原微生物、外源性大分子物质、同种异体移植物等产生免疫反应的生物屏障。[
Corrigendum
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勘误表：卵泡抑素样1通过转化生长因子β 1/丝裂原活化蛋白激酶信号通路促进博莱霉素诱导的肺纤维化中华医学杂志英文版2020年 133卷 14期
DOI: 10.1097/CM9.0000000000000952
摘要
在题为“卵泡抑素样1通过转化生长因子β 1/丝裂原活化蛋白激酶信号通路促进博莱霉素诱导的肺纤维化”的文章中，第16期，第131卷中华医学杂志,[
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