MedNexus
2020年 · 第133卷第18期
出版日期 2020-09-20电子版 ￥0.00元
MedNexus
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Editorial
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在冠状病毒疾病2019大流行中迅速组织重新部署的医务人员：我们应该做什么Meng Mei, Zhang Sheng, Zhai Chun-Juan, Chen De-Chang
中华医学杂志英文版2020年 133卷 18期
DOI: 10.1097/CM9.0000000000001033
摘要
冠状病毒疾病2019（新冠肺炎）疫情已经成为一场全球健康危机。[
Original Article
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去甲肾上腺素改变感染性休克患者早期复苏后平均动脉压对外周灌注指数的影响He Huai-Wu, Liu Wang-Lin, Zhou Xiang, Long Yun, Liu Da-Wei
中华医学杂志英文版2020年 133卷 18期
DOI: 10.1097/CM9.0000000000001017
摘要
Background:
The peripheral perfusion index (PI), as a real-time bedside indicator of peripheral tissue perfusion, may be useful for determining mean arterial pressure (MAP) after early resuscitation of septic shock patients. The aim of this study was to explore the response of PI to norepinephrine (NE)-induced changes in MAP.
Methods:
Twenty septic shock patients with pulse-induced contour cardiac output catheter, who had usual MAP under NE infusion after early resuscitation, were enrolled in this prospective, open-label study. Three MAP levels (usual MAP -10 mmHg, usual MAP, and usual MAP +10 mmHg) were obtained by NE titration, and the corresponding global hemodynamic parameters and PI were recorded. The general linear model with repeated measures was used for analysis of variance of related parameters at three MAP levels.
Results:
With increasing NE infusion, significant changes were found in MAP (F = 502.46, P < 0.001) and central venous pressure (F = 27.45, P < 0.001) during NE titration. However, there was not a significant and consistent change in continuous cardiac output (CO) (F = 0.41, P = 0.720) and PI (F = 0.73, P = 0.482) at different MAP levels. Of the 20 patients enrolled, seven reached the maximum PI value at usual MAP -10 mmHg, three reached the maximum PI value at usual MAP, and ten reached the maximum PI value at usual MAP +10 mmHg. The change in PI was not significantly correlated with the change in CO (r = 0.260, P = 0.269) from usual MAP -10 mmHg to usual MAP. There was also no significant correlation between the change in PI and change in CO (r = 0.084, P = 0.726) from usual MAP to usual MAP +10 mmHg.
Conclusions:
Differing MAP levels by NE infusion induced diverse PI responses in septic shock patients, and these PI responses may be independent of the change in CO. PI may have potential applications for MAP optimization based on changes in peripheral tissue perfusion.
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兔早期内毒素血症休克模型中微循环、大循环和乳酸水平之间的解离时间Zhang Hong, Li Lei, Wu Jun, Qu Hong-Ping, Tang Yao-Qing, Chen De-Chang
中华医学杂志英文版2020年 133卷 18期
DOI: 10.1097/CM9.0000000000000887
摘要
Background:
The relationship between macrocirculation and microcirculation remains controversial. The loss of coherence between microcirculation and macrocirculation has already been found in late-stage sepsis shock. The objective of this study was to determine the earliest possible time of detecting the loss of coherence between microcirculation and macrocirculation in early-stage endotoxemic shock.
Methods:
We randomized 24 female New Zealand white rabbits into two groups: endotoxemic shock group (n = 14) and control group (n= 10). Rabbits in the endotoxemic shock group were equipped with arterial and venous catheters and received an intravenous infusion of Escherichia coli lipopolysaccharide (LPS, 2 mg/kg over 10 min). Rabbits in the control group received the same dose of saline infusion. Microcirculatory perfusion parameters were assessed in the sublingual mucosa using sidestream dark-field video microscopy. Systemic hemodynamics and blood lactate levels were measured at baseline and over a 120-min period.
Results:
Ninety minutes after completing LPS infusion, all animals in the endotoxemic shock group developed a hypodynamic septic condition, characterized by low cardiac output and increased systemic vascular resistance; 120 min after completing LPS infusion, the mean arterial pressure decreased by 25% (P = 0.01), confirming ongoing endotoxemic shock. However, significant decreases in sublingual microcirculatory parameters of small vessels (microvascular flow index, perfused vessel density, and proportion of small perfused vessels) were observed 30 min after completing LPS infusion (P = 0.01, for all), and threshold decreases of 30% were found 60 min after completing LPS infusion (P = 0.001, for all) in the endotoxemic shock group. Lactate levels significantly increased to more than 2 mm/L at 90 min and more than 4 mm/L at 120 min in the endotoxemic shock group (P = 0.02 and P = 0.01, respectively).
Conclusions:
Changes in microcirculatory perfusion precede changes in macrocirculation and lactate levels in a rabbit model of endotoxemia shock. Microcirculation, macrocirculation, and oxygen metabolism are distinct in early-stage endotoxic shock.
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免疫缺陷在鲍曼不动杆菌小鼠相关性肺炎Liu Ai-Ran, Du Wen-Jing, Xie Jian-Feng, Xu Jing-Yuan, Huang Ying-Zi, Qiu Hai-Bo, Yang Yi
中华医学杂志英文版2020年 133卷 18期
DOI: 10.1097/CM9.0000000000001027
摘要
Background:
Acinetobacter baumannii (A. baumannii) has become one of the most important opportunistic pathogens inducing nosocomial pneumonia and increasing mortality in critically ill patients recently. The interaction between A. baumannii infection and immune response can influence the prognosis of A. baumannii related pneumonia. The target of the present study was to investigate the role of immunodeficiency in A. baumannii induced pneumonia.
Methods:
Male BALB/c mice were randomly divided into the normal immunity control (NIC) group, normal immunity infection (NIA) group, immune compromised control (CIC) group, and immune compromised infection (CIA) group (n = 15 for each group). Intraperitoneal injection of cyclophosphamide and intranasal instillation of A. baumannii solution were used to induce compromised immunity and murine pneumonia, respectively. The mice were sacrificed at 6 and 24 h later and the specimens were collected for further tests. Seven-day mortality of mice was also assessed.
Results:
After A. baumannii stimulation, the recruitment of neutrophils in mice with normal immunity increased sharply (P = 0.030 at 6 h), while there was no significant raise of neutrophil counts in mice with compromised immune condition (P = 0.092 at 6 h, P = 0.772 at 24 h). The Th cell polarization presented with pulmonary interleukin (IL)-4 and interferon (IFN)-γ level in response to the A. baumannii in CIA group were significantly depressed in comparison with in NIA group (IFN-γ: P = 0.003 at 6 h; P = 0.001 at 24 h; IL-4: P < 0.001 at 6 h; P < 0.001 at 24 h). The pulmonary conventional dendritic cell accumulation was even found to be inhibited after A. baumannii infection in immunocompromised mice (P= 0.033). Correspondingly, A. baumannii associated pneumonia in mice with compromised immunity caused more early stage death, more severe histopathological impairment in lung.
Conclusion:
A. baumannii could frustrate the immune response in immunocompromised conditions, and this reduced immune response is related to more severe lung injury and worse outcome in A. baumannii induced pneumonia.
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游离三碘甲状腺原氨酸对扩张型心肌病患者预后的价值Zhao Hong-Yan, Sun Ling, Zhu Ye-Qian, Chen Qiu-Shi, Zhu Wen-Wu, Toorabally Mohammad Bilaal, Chen Xin-Guang, Zhang Feng-Xiang
中华医学杂志英文版2020年 133卷 18期
DOI: 10.1097/CM9.0000000000000896
摘要
Background:
The association between free triiodothyronine (FT3) and long-term prognosis in dilated cardiomyopathy (DCM) patients has not been evaluated. The purpose of this study was to determine whether the level of FT3 could provide prognostic value in patients with DCM.
Methods:
Data of consecutive patients diagnosed with DCM were collected from October 2009 to December 2014. FT3 was measured by fluoroimmunoassay. Other biochemical markers, such as free thyroxin (FT4), thyroid-stimulating hormone, red blood cell, hemoglobin, blood urea nitrogen, and serum creatinine, were tested at the same time. Follow-up was performed every 3 months. The primary endpoint was all-cause mortality. Pearson analysis was used to evaluate the correlation of FT3 and other lab metrics with DCM patients’ prognosis. The association of long-term mortality in DCM and FT3 was compared using Cox hazards model.
Results:
Data of 176 patients diagnosed with DCM were collected. Of them, 24 patients missed FT3 values and six patients were lost to follow-up. Altogether, data of 146 patients were analyzed. During the median follow-up time of 79.9 (53.5-159.6) months, nine patients lost, 61 patients died (non-survival group), and 85 patients survived (survival group). FT3 was significantly lower in non-survival group than that in survival group (3.65 ± 0.83 pmol/L vs. 4.36 ± 1.91 pmol/L; P = 0.003). FT3 also showed a significantly positive correlation with red blood cell and hemoglobin, negatively correlated with age, blood urea nitrogen and serum creatinine (P < 0.05), respectively. Patients in the group of lower FT3 levels (FT3 ≤ 3.49 pmol/L) suffered from a higher risk of all-cause mortality (P for log-rank = 0.001). In multivariate Cox regression analysis, FT3 level was significantly associated with all-cause mortality (hazard ratio: 0.70, 95% confidence interval 0.52-0.95, P for trend = 0.021).
Conclusion:
Low levels of FT3 were associated with increased all-cause mortality in patients with DCM.
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MicroRNA-34c通过C-X-C基序配体14/Janus激酶2/信号转导子和转录激活子-3轴促进脊髓损伤大鼠神经元恢复Shen Juan, Gao Feng, Zhao Lin, Hao Qin, Yang Yan-Ling
中华医学杂志英文版2020年 133卷 18期
DOI: 10.1097/CM9.0000000000001022
摘要
Background:
Developing effective spinal cord repair strategies for spinal cord injury (SCI) is of great importance. Emerging evidence suggests that microRNAs (miRNAs) are closely linked to SCI recovery. This study aimed to investigate the function of miR-34c in the neuronal recovery in rats with SCI.
Methods:
A rat model with SCI was established. Differentially expressed miRNAs were identified by a microarray analysis. MiR-34c expression in rats was measured by reverse transcription quantitative polymerase chain reaction. Altered expression of miR-34c or C-X-C motif ligand 14 (CXCL14) was introduced in SCI rats to measure their roles in neuronal recovery. Western blot analysis was performed to determine the phosphorylation of Janus kinase 2 (JAK2) and signal transducer and activator of transcription-3 (STAT3). Neuronal apoptosis in rat spinal cord tissues was detected. The concentrations of SCI recovery-related proteins thyrotropin releasing hormone (TRH), prostacyclin (PGI2), and ganglioside (GM) were evaluated by enzyme-linked immunosorbent assay. Data were analyzed using a t-test with a one-way or two-way analysis of variance.
Results:
Rats with SCI presented decreased grip strength (112.03 ± 10.64 vs. 17.32 ± 1.49 g, P < 0.01), decreased miR-34c expression (7 days: 3.78 ± 0.44 vs. 0.95 ± 0.10, P < 0.05), and increased CXCL14 expression (7 days: 0.61 ± 0.06 vs. 2.91 ± 0.27, P < 0.01). MiR-34c was found to directly bind to CXCL14. Overexpression of miR-34c increased grip strength (11.23 ± 1.08 vs. 31.26 ± 2.99 g, P < 0.01) and reduced neuronal apoptosis in spinal cord tissues (53.61% ± 6.07% vs. 24.59% ± 3.32%, P < 0.01), and silencing of CXCL14 also increased the grip strength (12.76 ± 1.13 vs. 29.77 ± 2.75 g, P < 0.01) and reduced apoptosis in spinal cord tissues (55.74% ± 6.24% vs. 26.75% ± 2.84%, P < 0.01). In addition, miR-34c upregulation or CXCL14 downregulation increased the concentrations of TRH, PGI2, and GM, and reduced phosphorylation of JAK2 and STAT3 in rats with SCI (all P < 0.01).
Conclusion:
The study provided evidence that miR-34c could promote neuronal recovery in rats with SCI through inhibiting CXCL14 expression and inactivating the JAK2/STAT3 pathway. This study may offer new insights into SCI treatment.
Consensus Statement
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2019冠状病毒病重症患者镇痛镇静管理专家共识Yang Xiang-Hong, Hu Bo, Shang You, Liu Jiao, Zhong Ming, Shang Xiu-Lling, Wu Zhi-Xiong, Yu Zhui, Sun Ren-Hua, Wang Hong-Liang 等
中华医学杂志英文版2020年 133卷 18期
DOI: 10.1097/CM9.0000000000001034
摘要
冠状病毒疾病2019（新冠肺炎）已被宣布为全球疫情，是全球范围内的重大公共卫生问题。新冠肺炎是一种损害多器官的全身性疾病，其中以肺为主要靶器官。
Year in Review
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系统性红斑狼疮：2019年回顾Fan Yong, Hao Yan-Jie, Zhang Zhuo-Li
中华医学杂志英文版2020年 133卷 18期
DOI: 10.1097/CM9.0000000000000983
摘要
Systemic lupus erythematosus (SLE) is an autoimmune disease with extreme heterogeneity and potentially involvement of any organ or system. Numerous unanswered questions and challenges in SLE always prompt further exploration. In 2019, great progress in various aspects of SLE emerged. Both the classification criteria and management recommendation for SLE were updated. New promising medications have been widely developed and tested, although subsequent clinical studies are warranted. As an emerging number of most notable studies in SLE were published in both clinical area and basic research in 2019, we aim to summarize the highest quality data on SLE regarding novel insights of pathogenesis, updated recommendations, hot-spot issues on clinical manifestations, new understanding of disease prognosis, and most importantly, the therapeutic advances in SLE in this review.
Review Article
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重症监护病房机械动力研究进展Chi Yi, He Huai-Wu, Long Yun
中华医学杂志英文版2020年 133卷 18期
DOI: 10.1097/CM9.0000000000001018
摘要
Mechanical power of ventilation, currently defined as the energy delivered from the ventilator to the respiratory system over a period of time, has been recognized as a promising indicator to evaluate ventilator-induced lung injury and predict the prognosis of ventilated critically ill patients. Mechanical power can be accurately measured by the geometric method, while simplified equations allow an easy estimation of mechanical power at the bedside. There may exist a safety threshold of mechanical power above which lung injury is inevitable, and the assessment of mechanical power might be helpful to determine whether the extracorporeal respiratory support is needed in patients with acute respiratory distress syndrome. It should be noted that relatively low mechanical power does not exclude the possibility of lung injury. Lung size and inhomogeneity should also be taken into consideration. Problems regarding the safety limits of mechanical power and contribution of each component to lung injury have not been determined yet. Whether mechanical power-directed lung-protective ventilation strategy could improve clinical outcomes also needs further investigation. Therefore, this review discusses the algorithms, clinical relevance, optimization, and future directions of mechanical power in critically ill patients.
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脓毒症心肌病的诱导和推断：五种典型类别Wang Jie, Wang Xiao-Ting, Liu Da-Wei, Zhang Hong-Min, Su Long-Xiang
中华医学杂志英文版2020年 133卷 18期
DOI: 10.1097/CM9.0000000000000929
摘要
Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection. The heart is one of the most important oxygen delivery organs, and dysfunction significantly increases the mortality of the body. Hence, the heart has been studied in sepsis for over half a century. However, the definition of sepsis-induced cardiomyopathy is not unified yet, and the conventional conception seems outdated: left ventricular systolic dysfunction (LVSD) along with enlargement of the left ventricle, recovering in 7 to 10 days. With the application of echocardiography in intensive care units, not only LVSD but also left ventricular diastolic dysfunction, right ventricular dysfunction, and even diffuse ventricular dysfunction have been seen. The recognition of sepsis-induced cardiomyopathy is gradually becoming complete, although our understanding of it is not deep, which has made the diagnosis and treatment stagnate. In this review, we summarize the research on sepsis-induced cardiomyopathy. Women and young people with septic cardiomyopathy are more likely to have LVSD, which may have the same mechanism as stress cardiomyopathy. Elderly people with ischemic cardiomyopathy and hypertension tend to have left ventricular diastolic dysfunction. Patients with mechanical ventilation, acute respiratory distress syndrome or other complications of increased right ventricular afterload mostly have right ventricular dysfunction. Diffuse cardiac dysfunction has also been shown in some studies; patients with mixed or co-existing cardiac dysfunction are more common, theoretically. Thus, understanding the pathophysiology of sepsis-induced cardiomyopathy from the perspective of critical care echocardiography is essential.
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肠-淋巴-肺通路介导脓毒症诱导的急性肺损伤Jin Can, Chen Jie, Gu Juan, Zhang Wei
中华医学杂志英文版2020年 133卷 18期
DOI: 10.1097/CM9.0000000000000928
摘要
This review attempts to unveil the possible mechanisms underlying how gut lymph affects lung and further gives rise to acute respiratory distress syndrome, as well as potential interventional targets under the condition of ischemia-reperfusion injury. We searched electronic databases including PubMed, MEDLINE, Cochrane Central Register of Controlled Trials, Google Scholar, Web of Science, and Embase to identify relevant literatures published up to December 2019. We enrolled the literatures including the Mesh Terms of "gut lymph or intestinal lymph and acute lung injury or acute respiratory distress syndrome." Gut is considered to be the origin of systemic inflammation and the engine of multiple organ distress syndrome in the field of critical care medicine, whereas gut lymph plays a pivotal role in initiation of ischemia-reperfusion injury-induced acute respiratory distress syndrome. In fact, in the having been established pathologic model of sepsis leading to multiple organ dysfunction named by Gut Lymph theory, a variety of literatures showed the position and role of changes in gut lymph components in the initiation of systemic inflammatory response, which allows us to screen out potential intervention targets to pave the way for future clinic and basic research.
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新生儿败血症：国内外Dong Ying, Basmaci Romain, Titomanlio Luigi, Sun Bo, Mercier Jean-Christophe
中华医学杂志英文版2020年 133卷 18期
DOI: 10.1097/CM9.0000000000000935
摘要
Sepsis remains a significant cause of neonatal morbidity and mortality in China. A better understanding of neonatal sepsis in China as compared with other industrialized and non-industrialized countries may help optimize neonatal health care both regionally and globally. Literature cited in this review was retrieved from PubMed using the keywords "neonatal sepsis," "early-onset (EOS)" and "late-onset (LOS)" in English, with the focus set on population-based studies. This review provides an updated summary regarding the epidemiology, pathogen profile, infectious work-up, and empirical treatment of neonatal sepsis within and beyond China. The incidence of neonatal EOS and the proportion of Group B Streptococcus (GBS) within pathogens causing EOS in China seem to differ from those in developed countries, possibly due to different population characteristics and intrapartum/postnatal health care strategies. Whether to adopt GBS screening and intrapartum antibiotic prophylaxis in China remains highly debatable. The pathogen profile of LOS in China was shown to be similar to other countries. However, viruses as potential pathogens of neonatal LOS have been underappreciated. Growing antimicrobial resistance in China reflects limitations in adapting antibiotic regimen to local microbial profile and timely cessation of treatment in non-proven bacterial infections. This review stresses that the local epidemiology of neonatal sepsis should be closely monitored in each institution. A prompt and adequate infectious work-up is critically important in diagnosing neonatal sepsis. Adequate and appropriate antibiotic strategies must be overemphasized to prevent the emergence of multi-resistant bacteria in China.
Meta Analysis
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血红蛋白A1c水平对接受经皮冠状动脉介入治疗的非糖尿病患者预后意义的荟萃分析Li Yan, Li Xiao-Wen, Zhang Yin-Hua, Zhang Lei-Min, Wu Qing-Qing, Bai Zhao-Run, Si Jin, Zuo Xue-Bing, Shi Ning, Li Jing 等
中华医学杂志英文版2020年 133卷 18期
DOI: 10.1097/CM9.0000000000001029
摘要
Background:
The predictive value of hemoglobin A1c (HbA1c) levels in non-diabetic patients with myocardial infarction undergoing percutaneous coronary intervention (PCI) is still controversial. This study aimed to evaluate whether HbA1c levels were independently associated with adverse clinical outcomes in non-diabetic patients with coronary artery disease (CAD) who had undergone PCI by performing a meta-analysis of cohort studies.
Methods:
This meta-analysis included non-diabetic patients with CAD who had undergone PCI. A systematic search for publications listed in the PubMed, Embase, and Cochrane Library databases from commencement to December 2018 was conducted. Studies evaluating the adverse clinical outcomes according to abnormal HbA1c levels in non-diabetic patients diagnosed with CAD who had undergone PCI were eligible. The primary outcomes were long-term all-cause deaths and long-term major adverse cardiac events, and the secondary outcome was short-term all-cause deaths. The meta-analysis was conducted with RevMan 5.3 and Stata software 14.0. Odds ratios (ORs) were pooled using a random or fixed-effects model, depending on the heterogeneity of the included studies. Sub-group analysis or sensitivity analysis was conducted to explore potential sources of heterogeneity, when necessary.
Results:
Six prospective cohort studies involving 10,721 patients met the inclusion criteria. From the pooled analysis, abnormal HbA1c levels were associated with increased risk for long-term all-cause death (OR 1.39, 95% confidence interval [CI] 1.16-1.68, P = 0.001, I2 = 45%). Sub-group analysis suggested that abnormal HbA1c levels between 6.0% and 6.5% predicted higher long-term major adverse cardiac event (including all-cause deaths, non-fatal myocardial infarction, target lesion revascularization, target vessel revascularization, recurrent acute myocardial infarction, heart failure requiring hospitalization, and stent thrombosis) risk (OR 2.05, 95% CI 1.46-2.87, P < 0.001, I2 = 0). Contrarily, elevated HbA1c levels were not associated with increased risk of short-term all-cause death (OR 1.16, 95% CI 0.88-1.54, P = 0.300, I2= 0).
Conclusions:
An abnormal HbA1c level is an independent risk factor for long-term adverse clinical events in non-diabetic patients with CAD after PCI. Strict control of HbA1c levels may improve patient survival. Further studies in different countries and prospective cohort studies with a large sample size are required to verify the association.
Perspective
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骨膜素在皮肤创伤愈合和病理性瘢痕形成中的作用Yin Shi-Lu, Qin Ze-Lian, Yang Xin
中华医学杂志英文版2020年 133卷 18期
DOI: 10.1097/CM9.0000000000000949
摘要
皮肤是最外层的保护性器官，容易受到外部损伤的损害，并且在伤口愈合后保留不希望的疤痕，这通常会降低生活质量并导致经济负担。骨膜素是一种细胞外基质成分，据报道与皮肤伤口愈合和病理性瘢痕形成密切相关。它在各种正常组织中表达，通常与成纤维细胞相关，并参与细胞外基质环境的重塑。[
Viewpoint
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聚焦2019冠状病毒病相关凝血病Yang Xiang-Hong, Li Ran-Ran, Sun Ren-Hua, Liu Jiao, Chen De-Chang
中华医学杂志英文版2020年 133卷 18期
DOI: 10.1097/CM9.0000000000001019
摘要
2019冠状病毒病（新冠肺炎）已引起全球爆发，并成为全球重大公共卫生问题。研究发现，新冠肺炎患者普遍并发凝血异常，凝血异常与患者的严重程度和预后密切相关。全面了解新冠肺炎患者凝血病的患病率和凝血参数异常的潜在原因，对于临床医生规范新冠肺炎相关凝血病的诊断和管理至关重要。
Clinical Observation
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体外膜肺氧合在心源性休克患者中的临床疗效：一项多中心研究Dai Qing-Qing, Liu Yan, Ren Yu-Dong, Yu Kai-Jiang, Wang Hong-Liang
中华医学杂志英文版2020年 133卷 18期
DOI: 10.1097/CM9.0000000000001030
摘要
心源性休克（CS）是重症监护室中一种危及生命的疾病，导致许多危重患者死亡。尽管CS患者的存活率似乎有所提高，但其预后仍然较差，死亡率在60%至80%之间。[
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入院高血糖对缺血性卒中伴或不伴糖尿病患者溶栓结局的预后价值Fang Hong-Juan, Pan Yue-Song, Wang Yong-Jun, Wang Chun-Xue, Wang Yi-Long, Zhong Li-Yong
中华医学杂志英文版2020年 133卷 18期
DOI: 10.1097/CM9.0000000000001005
摘要
症状发作4.5 h内溶栓治疗是公认的急性缺血性卒中（AIS）有效且标准的治疗方法，但仍有部分患者临床结局较差。评估和控制AIS不良临床结局的预测因素对于实现最佳治疗是不可或缺的，但入院血糖（ABG）对此的预后价值尚不清楚，仍在争论中。在无糖尿病（DM）患者中评估的ABG常提示急性应激性高血糖，而ABG可能与DM患者的长期血糖控制有密切关系。然而，在大多数关于ABG对AIS后重组组织型纤溶酶原激活剂（rtPA）治疗预后影响的研究中，患者没有被分为有和没有DM的患者。本研究旨在根据中国人群的DM状态调查ABG对溶栓后AIS临床结局的预后价值。
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7例胱硫醚β-合酶缺乏症患者脑静脉窦血栓形成的高患病率Wen Yan-Bin, Chen Jun, Xiao Li-Jun, Feng Jie, Gu Wen-Ping
中华医学杂志英文版2020年 133卷 18期
DOI: 10.1097/CM9.0000000000001013
摘要
胱硫醚-β-合酶（CBS）缺乏引起的同型胱氨酸尿症是一种罕见的遗传性疾病，最常在儿童期诊断，可导致多系统损伤。[
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ESKAPE和大肠杆菌在中国一家三级医院从血液中分离出来Wei Dan-Dan, Gao Jing, Yang Rui-Lin, Bai Chun-Yang, Lin Xu-Hong
中华医学杂志英文版2020年 133卷 18期
DOI: 10.1097/CM9.0000000000000987
摘要
由于其发病率、死亡率和相关的医疗费用不断增加，血流感染（BSIs）已成为全球关注的问题。ESKAPE中的菌株包括屎肠球菌(屎肠球菌),金黄色葡萄球菌(金黄色葡萄球菌),肺炎克雷伯菌(K.肺炎),鲍曼不动杆菌(鲍曼不动杆菌),铜绿假单胞菌(铜绿假单胞菌），以及肠杆菌spp.，以及大肠杆菌(大肠杆菌），占BSI致病病原体的一半以上。[
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Wells评分联合D-二聚体水平对冠心病胸痛患者急性肺栓塞的预测价值Wang Jing, Wu Xiao-Yan, Liang Ying, Guo Wei
中华医学杂志英文版2020年 133卷 18期
DOI: 10.1097/CM9.0000000000000988
摘要
急性肺栓塞（APE）是一种具有挑战性的疾病，经常漏诊或延迟诊断，因此可能是致命的。在有冠心病病史的急诊患者中，心电图（ECG）结果往往不具有特异性，APE难以诊断。因此，患者倾向于被诊断为急性冠状动脉综合征（ACS），并且要么在急诊科接受心肌酶观察的复查，要么入院进行冠状动脉造影。2008年欧洲心脏病学会（ESC）急性肺栓塞诊断和处理指南指出，APE的临床风险评估应以Wells评分为依据。[
Technical Notes
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改良颞下窝B型入路在侧颅底肿瘤切除术中的应用Xue Yu-Bin, Wang Pu, Xia Yin, Liu Qiang, Zhang Wen-Yang
中华医学杂志英文版2020年 133卷 18期
DOI: 10.1097/CM9.0000000000000998
摘要
颞下窝入路设计用于切除位于颞骨和侧颅底的大肿瘤。[
Image
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非隔离肺的异常全身动脉：多层计算机断层扫描特征Kang Bing, Ma Yan, Li Kai, Wang Xi-Heng, Sun Cong, Wang Xi-Ming
中华医学杂志英文版2020年 133卷 18期
DOI: 10.1097/CM9.0000000000000965
摘要
非隔离肺的异常全身动脉（ASANSL）是一种罕见的先天性异常，以前被归类为Pryce I型隔离；它包括通往正常肺的异常全身动脉（ASA）。[
Correspondence
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功能性踝关节不稳定鉴定问卷中译本的验证Guo Hao, Huang Wei-Qi, Lin Xi-Jiang, Chen Bo-Tao, Zeng Can-Jun
中华医学杂志英文版2020年 133卷 18期
DOI: 10.1097/CM9.0000000000001020
摘要
致编辑：踝关节扭伤约占所有运动损伤的40%，20%~33%的踝关节扭伤会导致踝关节不稳定。[
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胰腺弥漫性浸润性血管瘤伴Kasabach-Merritt综合征1例Zhang Wen-Hua, Luo Fang-Qiong, Wang Hui
中华医学杂志英文版2020年 133卷 18期
DOI: 10.1097/CM9.0000000000001037
摘要
致编辑：Kasabach-Merritt综合征（KMS）是一种非常罕见的危及生命的侵袭性血管肿瘤，与Kaposiform血管内皮瘤和簇状血管瘤有关。以血小板减少和血管内凝血为特征，偶尔发展为弥散性血管内凝血。[
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杨新石片剂通过缓解他汀类药物诱导的骨骼肌损伤增强对运动训练的适应性Wu Ruo-Ming, Jiang Bing, Li Hui, Dang Wen-Zhen, Zhang Cong, Zhong Xiao-Zheng, Hong Yi, Ye Guan, Shen Xiao-Yan
中华医学杂志英文版2020年 133卷 18期
DOI: 10.1097/CM9.0000000000001028
摘要
致编辑：广泛使用的他汀类药物降低了心血管疾病的死亡风险。然而，他汀类药物相关的骨骼肌主诉在一定程度上阻碍了其临床应用。杨新石中药配方片（YXST）与常规药物合用，可有效改善心血管疾病患者的临床症状。然而，YXST与他汀类药物联合使用的协同作用和潜在机制仍然未知。因此，探讨YXST改善他汀类药物诱导的肌肉损伤的作用和机制可能有利于心血管疾病患者的运动康复和预后。
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