MedNexus
2021年 · 第134卷第02期
出版日期 2021-01-20电子版 ￥0.00元
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Review Article
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脑小血管病的临床治疗：呼唤整体方法Una Clancy, Jason P. Appleton, Carmen Arteaga, Fergus N. Doubal, Philip M. Bath, Joanna M. Wardlaw
中华医学杂志英文版2021年 134卷 02期
DOI: 10.1097/CM9.0000000000001177
摘要
Cerebral small vessel disease (SVD) is a common global brain disease that causes cognitive impairment, ischemic or hemorrhagic stroke, problems with mobility, and neuropsychiatric symptoms. The brain damage, seen as focal white and deep grey matter lesions on brain magnetic resonance imaging (MRI) or computed tomography (CT), typically accumulates "covertly" and may reach an advanced state before being detected incidentally on brain scanning or causing symptoms. Patients have typically presented to different clinical services or been recruited into research focused on one clinical manifestation, perhaps explaining a lack of awareness, until recently, of the full range and complexity of SVD.
In this review, we discuss the varied clinical presentations, established and emerging risk factors, relationship to SVD features on MRI or CT, and the current state of knowledge on the effectiveness of a wide range of pharmacological and lifestyle interventions. The core message is that effective assessment and clinical management of patients with SVD, as well as future advances in diagnosis, care, and treatment, will require a more "joined-up" ’ approach. This approach should integrate clinical expertise in stroke neurology, cognitive, and physical dysfunctions. It requires more clinical trials in order to improve pharmacological interventions, lifestyle and dietary modifications. A deeper understanding of the pathophysiology of SVD is required to steer the identification of novel interventions. An essential prerequisite to accelerating clinical trials is to improve the consistency, and standardization of clinical, cognitive and neuroimaging endpoints.
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老龄化社会的大流行——散发性脑小血管病Alexander Yuk Lun Lau, Bonaventure Yiu Ming Ip, Ho Ko, Bonnie Yin Ka Lam, Lin Shi, Karen Ka Yan Ma, Lisa Wing Chi Au, Yannie Oi Yan Soo, Thomas Wai Hong Leung, Adrian Wong 等
中华医学杂志英文版2021年 134卷 02期
DOI: 10.1097/CM9.0000000000001320
摘要
Age-related sporadic cerebral small vessel disease (CSVD) has gained increasing attention over the past decades because of its increasing prevalence associated with an aging population. The widespread application of and advances in brain magnetic resonance imaging in recent decades have significantly increased researchers’ understanding in the in vivo evolution of CSVD, its impact upon the brain, its risk factors, and the mechanisms that explain the various clinical manifestation associated with sporadic CSVD. In this review, we aimed to provide an update on the pathophysiology, risk factors, biomarkers, and the determinants and spectrum of the clinical manifestation of sporadic CSVD.
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脑小血管病的磁共振成像表现：自动定量及临床应用Lei Zhao, Allan Lee, Yu-Hua Fan, Vincent C.T. Mok, Lin Shi
中华医学杂志英文版2021年 134卷 02期
DOI: 10.1097/CM9.0000000000001299
摘要
The common cerebral small vessel disease (CSVD) neuroimaging features visible on conventional structural magnetic resonance imaging include recent small subcortical infarcts, lacunes, white matter hyperintensities, perivascular spaces, microbleeds, and brain atrophy. The CSVD neuroimaging features have shared and distinct clinical consequences, and the automatic quantification methods for these features are increasingly used in research and clinical settings. This review article explores the recent progress in CSVD neuroimaging feature quantification and provides an overview of the clinical consequences of these CSVD features as well as the possibilities of using these features as endpoints in clinical trials. The added value of CSVD neuroimaging quantification is also discussed for researches focused on the mechanism of CSVD and the prognosis in subjects with CSVD.
Medical Progress
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放射性肺损伤机制研究进展Hang-Jie Ying, Min Fang, Ming Chen
中华医学杂志英文版2021年 134卷 02期
DOI: 10.1097/CM9.0000000000001032
摘要
放射治疗广泛用于治疗各种胸部肿瘤。然而，X射线在杀伤肿瘤细胞的同时不可避免地对正常肺组织造成损伤，导致放射性肺损伤（RILI）的发生。最近的数据显示，肺癌的RILI发病率最高（5-25%），其次是纵隔淋巴瘤（5-10%）和乳腺癌（1-5%）。[
Original Article
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100 mg阿司匹林每日两次与利伐沙班预防初次全髋关节置换术后静脉血栓栓塞的疗效相当：一项随机对照试验Yi Ren, Shi-Liang Cao, Zeng Li, Tim Luo, Bin Feng, Xi-Sheng Weng
中华医学杂志英文版2021年 134卷 02期
DOI: 10.1097/CM9.0000000000001305
摘要
Background:
Aspirin has demonstrated safety and efficacy for venous thromboembolism (VTE) prophylaxis following total hip arthroplasty (THA); however, inconsistent dose regimens have been reported in the literature. This study aimed to evaluate and compare the safety and efficacy of 100 mg aspirin twice daily with rivaroxaban in VTE prophylaxis following THA.
Methods:
Patients undergoing elective unilateral primary THA between January 2019 and January 2020 were prospectively enrolled in the study and randomly allocated to receive 5 weeks of VTE prophylaxis with either oral enteric-coated aspirin (100 mg twice daily) or rivaroxaban (10 mg once daily). Medication safety and efficacy were comprehensively evaluated through symptomatic VTE incidence, deep vein thrombosis (DVT) on Doppler ultrasonography, total blood loss (TBL), laboratory bloodwork, Harris hip score (HHS), post-operative recovery, and the incidence of other complications.
Results:
We included 70 patients in this study; 34 and 36 were allocated to receive aspirin and rivaroxaban prophylaxis, respectively. No cases of symptomatic VTE occurred in this study. The DVT rate on Doppler ultrasonography in the aspirin group was not significantly different from that in the rivaroxaban group (8.8% vs. 8.3%, χ2 = 0.01, P = 0.91), confirming the non-inferiority of aspirin for DVT prophylaxis (χ2 = 2.29, P = 0.01). The calculated TBL in the aspirin group (944.9 mL [658.5-1137.8 mL]) was similar to that in the rivaroxaban group (978.3 mL [747.4-1740.6mL]) (χ2 = 1.55, P = 0.12). However, there were no significant inter-group differences in HHS at post-operative day (POD) 30 (Aspirin: 81.0 [78.8-83.0], Rivaroxaban: 81.0 [79.3-83.0], χ2 = 0.43, P = 0.67) and POD 90 (Aspirin: 90.0 [89.0-92.0], Rivaroxaban: 91.5 [88.3-92.8], χ2 = 0.77, P = 0.44), the incidence of bleeding events (2.9% vs. 8.3%, χ2 = 0.96, P = 0.33), or gastrointestinal complications (2.9% vs. 5.6%, χ2 = 1.13, P = 0.29).
Conclusion:
In terms of safety and efficacy, the prophylactic use of 100 mg aspirin twice daily was not statistically different from that of rivaroxaban in preventing VTE and reducing the risk of blood loss following elective primary THA. This supports the use of aspirin chemoprophylaxis following THA as a less expensive and more widely available option for future THAs.
Trial Registration:
Chictr.org, ChiCTR18000202894; http://www.chictr.org.cn/showproj.aspx?proj=33284
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辛辣食物消费与阿尔茨海默病的认知和脑脊液生物标志物相关Ding-Yuan Tian, Jun Wang, Bin-Lu Sun, Zhen Wang, Wei Xu, Yang Chen, Ying-Ying Shen, Hui-Yun Li, Dong-Wan Chen, Fa-Ying Zhou 等
中华医学杂志英文版2021年 134卷 02期
DOI: 10.1097/CM9.0000000000001318
摘要
Background:
Recent studies suggest that a healthy diet helps to prevent the development of Alzheimer disease (AD). This study aimed to investigate whether spicy food consumption is associated with cognition and cerebrospinal fluid (CSF) biomarkers of AD in the Chinese population.
Methods:
We enrolled 55 AD patients and 55 age- and gender-matched cognitively normal (CN) subjects in a case-control study, as well as a cohort of 131 participants without subjective cognitive decline (non-AD) in a cross-sectional study. Spicy food consumption was assessed using the Food Frequency Questionnaire (FFQ). Associations of FFQ scores with cognition and CSF biomarkers of AD were analyzed.
Results:
In the case-control study, spicy food consumption was lower in AD patients than that in CNs (4.0 [4.0-8.0] vs. 8.0 [4.5-10.0], P < 0.001); FFQ scores were positively associated with Mini-Mental Status Examination scores in the total sample (r = 0.218, P = 0.014). In the cross-sectional study, the association between spicy food consumption and cognition levels was verified in non-AD subjects (r = 0.264, P = 0.0023). Moreover, higher FFQ scores were significantly associated with higher β-Amyloid (1-42) (Aβ42) levels and lower phospho-tau/Aβ42 and total tau/Aβ42 ratios in the CSF of non-AD subjects (P < 0.05).
Conclusion:
Spicy food consumption is closely related to higher cognition levels and reversed AD biomarkers in the CSF, suggesting that a capsaicin-rich diet might have the potential to modify the cognitive status and cerebral pathologies associated with AD.
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HTRA1-相关常染色体显性脑小血管病Jing-Yi Liu, Yi-Cheng Zhu, Li-Xin Zhou, Yan-Ping Wei, Chen-Hui Mao, Li-Ying Cui, Bin Peng, Ming Yao
中华医学杂志英文版2021年 134卷 02期
DOI: 10.1097/CM9.0000000000001176
摘要
Background:
Homozygous or compound heterozygous mutations in high temperature requirement serine peptidase A1 (HTRA1) gene are responsible for cerebral autosomal recessive arteriopathy with subcortical infarcts and leukoencephalopathy (CARASIL). Recently, increasing evidence has shown that heterozygous HTRA1 mutations are also associated with cerebral small vessel disease (CSVD) with an autosomal dominant pattern of inheritance. This study was aimed to analyze the genetic and clinical characteristics of HTRA1-related autosomal dominant CSVD.
Methods:
We presented three new Chinese cases of familial CSVD with heterozygous HTRA1 mutations and reviewed all clinical case reports and articles on HTRA1-related autosomal dominant CSVD included in PUBMED by the end of March 1, 2020. CARASIL probands with genetic diagnosis reported to date were also reviewed. The genetic and clinical characteristics of HTRA1-related autosomal dominant CSVD were summarized and analyzed by comparing with CARASIL.
Results:
Forty-four HTRA1-related autosomal dominant CSVD probands and 22 CARASIL probands were included. Compared with typical CARASIL, HTRA1-related autosomal dominant probands has a higher proportion of vascular risk factors (P < 0.001), a later onset age (P < 0.001), and a relatively slower clinical progression. Alopecia and spondylosis can be observed, but less than those in the typical CARASIL. Thirty-five heterozygous mutations in HTRA1 were reported, most of which were missense mutations. Amino acids located close to amino acids 250-300 were most frequently affected, followed by these located near 150∼200. While amino acids 250∼300 were also the most frequently affected region in CARASIL patients, fewer mutations precede the 200th amino acids were detected, especially in the Kazal-type serine protease domain.
Conclusions:
HTRA1-related autosomal dominant CSVD is present as a mild phenotype of CARASIL. The trend of regional concentration of mutation sites may be related to the concentration of key sites in these regions which are responsible for pathogenesis of HTRA1-related autosomal dominant CSVD.
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麝香保心丸（MUSKARDIA）对稳定型冠心病患者的疗效和安全性：一项多中心、双盲、安慰剂对照的IV期随机临床试验Jun-Bo Ge, Wei-Hu Fan, Jing-Min Zhou, Hai-Ming Shi, Fu-Sui Ji, Yang Wu, Yu-Lan Zhao, Jun Qian, Yuan-Zhe Jin, Ying-Wu Liu 等
中华医学杂志英文版2021年 134卷 02期
DOI: 10.1097/CM9.0000000000001257
摘要
Background:
The Shexiang Baoxin Pill (MUSKARDIA) has been used for treating coronary artery disease (CAD) and angina for more than 30 years in China. Nevertheless, methodologically sound trials on the use of MUSKARDIA in CAD patients are scarce. The aim of the study is to determine the effects of MUSKARDIA as an add-on to optimal medical therapy (OMT) in patients with stable CAD.
Methods:
A total of 2674 participants with stable CAD from 97 hospitals in China were randomized 1:1 to a MUSKARDIA or placebo group for 24 months. Both groups received OMT according to local tertiary hospital protocols. The primary outcome was the occurrence of a major adverse cardiovascular event (MACE), defined as a composite of cardiovascular death, non-fatal myocardial infarction (MI), or non-fatal stroke. Secondary outcomes included all-cause mortality, non-fatal MI, non-fatal stroke, hospitalization for unstable angina or heart failure, peripheral revascularization, angina stability and angina frequency.
Results:
In all, 99.7% of the patients were treated with aspirin and 93.0% with statin. After 2 years of treatment, the occurrence of MACEs was reduced by 26.9% in the MUSKARDIA group (MUSKARDIA: 1.9% vs. placebo: 2.6%; odds ratio = 0.80; 95% confidence interval: 0.45-1.07; P = 0.2869). Angina frequency was significantly reduced in the MUSKARDIA group at 18 months (P = 0.0362). Other secondary endpoints were similar between the two groups. The rates of adverse events were also similar between the two groups (MUSKARDIA: 17.7% vs. placebo: 17.4%, P = 0.8785).
Conclusions:
As an add-on to OMT, MUSKARDIA is safe and significantly reduces angina frequency in patients with stable CAD. Moreover, the use of MUSKARDIA is associated with a trend toward reduced MACEs in patients with stable CAD. The results suggest that MUSKARDIA can be used to manage patients with CAD.
Trial registration:
chictr.org.cn, No. ChiCTR-TRC-12003513
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微尺度子宫内膜取样活检在1551名妇女人群中检测子宫内膜癌和不典型增生：与宫腔镜子宫内膜活检的对照研究Guo Zhang, Yue Wang, Xu-Dong Liang, Rong Zhou, Xiu-Li Sun, Jian-Liu Wang, Li-Hui Wei
中华医学杂志英文版2021年 134卷 02期
DOI: 10.1097/CM9.0000000000001109
摘要
Background:
Endometrial cancer is one of the most common malignancies of the reproductive system. Effective and cost-effective screening method for populations at high risk is not available. This study aimed to investigate specimen adequacy and the influencing factors in microscale endometrial sampling biopsy and to evaluate the diagnostic accuracy and medical cost of biopsy in endometrial cancer and atypical hyperplasia screenings in comparison with hysteroscopic endometrial biopsy.
Methods:
A total of 1551 patients at high risk for endometrial lesions who required hysteroscopic endometrial biopsy from November 2017 to August 2018 were included. Microscale endometrial sampling biopsy was performed, followed by hysteroscopic endometrial biopsy. We evaluated the specimen adequacy and influencing factors of microscale endometrial sampling. Diagnostic consistency between microscale endometrial sampling biopsy and hysteroscopic endometrial biopsy was evaluated. The sensitivity, specificity, positive predictive value, and negative predictive value of microscale endometrial sampling biopsy in screening for endometrial cancer and atypical hyperplasia were analyzed, and the medical costs of the two procedures were compared.
Results:
The specimen adequacy was 81.2%. Patient age, menopausal status, endometrial thickness, and endometrial lesion type were correlated with specimen adequacy. There was good consistency in distinguishing benign and malignant endometrial diseases between microscale endometrial sampling biopsy and hysteroscopic biopsy (kappa 0.950, 95% CI 0.925-0.975). The sensitivity, specificity, positive predictive value, and negative predictive value of microscale endometrial sampling biopsy were 91.7%, 100.0%, 100.0%, and 99.3% for endometrial cancer screening, respectively, and 82.0%, 100.0%, 100.0%, and 99.4% for atypical hyperplasia screening. The medical cost of endometrial sampling biopsy was only 22.1% of the cost of hysteroscopic biopsy.
Conclusions:
Microscale endometrial sampling biopsy is a minimally invasive alternative technique for obtaining adequate endometrial specimens for histopathological examination. It has the potential to be used in detecting endometrial cancer and atypical hyperplasia with high efficiency and low cost.
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中国盆底手术与盆腔器官脱垂相关的14年多机构合作研究Zhi-Jing Sun, Xiu-Qi Wang, Jing-He Lang, Tao Xu, Yong-Xian Lu, Ke-Qin Hua, Jin-Song Han, Huai-Fang Li, Xiao-Wen Tong, Ping Wang 等
中华医学杂志英文版2021年 134卷 02期
DOI: 10.1097/CM9.0000000000001237
摘要
Background:
It has been a global trend that increasing complications related to pelvic floor surgeries have been reported over time. The current study aimed to outline the development of Chinese pelvic floor surgeries related to pelvic organ prolapse (POP) over the past 14 years and investigate the potential influence of enhanced monitoring conducted by the Chinese Association of Urogynecology since 2011.
Methods:
A total of 44,594 women with POP who underwent pelvic floor surgeries between October 1, 2004 and September 30, 2018 were included from 22 tertiary academic medical centers. The data were reported voluntarily and obtained from a database. We compared the proportion of each procedure in the 7 years before and 7 years after September 30, 2011. The data were analyzed by performing Z test (one-sided).
Results:
The number of different procedures during October 1, 2011-September 30, 2018 was more than twice that during October 1, 2004-September 30, 2011. Regarding pelvic floor surgeries related to POP, the rate of synthetic mesh procedures increased from 38.1% (5298/13,906) during October 1, 2004-September 30, 2011 to 46.0% (14,107/30,688) during October 1, 2011-September 30, 2018, whereas the rate of non-mesh procedures decreased from 61.9% (8608/13,906) to 54.0% (16,581/30,688) (Z = 15.53, P < 0.001). Regarding synthetic mesh surgeries related to POP, the rates of transvaginal placement of surgical mesh (TVM) procedures decreased from 94.1% (4983/5298) to 82.2% (11,603/14,107) (Z = 20.79, P < 0.001), but the rate of laparoscopic sacrocolpopexy (LSC) procedures increased from 5.9% (315/5298) to 17.8% (2504/14,107).
Conclusions:
The rate of synthetic mesh procedures increased while that of non-mesh procedures decreased significantly. The rate of TVM procedures decreased while the rate of LSC procedures increased significantly.
Trial registration number:
NCT03620565, https://register.clinicaltrials.gov.
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肾病综合征和微小病变患者急性肾损伤的临床特征：一项回顾性、横断面研究Shu-Peng Lin, Feng-Ge Zhu, Jin-Ling Meng, Xiao-Wei Sun, Jing Cui, Shuang Liang, Zhong Yin, Xue-Feng Sun, Guang-Yan Cai
中华医学杂志英文版2021年 134卷 02期
DOI: 10.1097/CM9.0000000000001218
摘要
Background:
Minimal change nephropathy (MCD) is a common pathological type of nephrotic syndrome and is often associated with acute kidney injury (AKI). This study aimed to investigate the clinical characteristics and related factors of AKI in patients with MCD and nephrotic syndrome.
Methods:
Patients from Chinese People’s Liberation Army General Hospital who were diagnosed with pathological renal MCD with clinical manifestations of nephrotic syndrome were included from January 1, 2013 to December 31, 2017. Patients diagnosed with membranous nephropathy (MN) by renal biopsy from January 1, 2013 to December 31, 2017 are included as a control population. We retrospectively analyzed the clinical and pathological characteristics of patients as well as the percentages and clinical characteristics of AKI in different age groups. We assessed the correlation of pathological characteristics with serum creatinine using multivariate linear regression analysis.
Results:
A total of 367 patients with MCD were included in the analysis, with a sex ratio of 1.46: 1 (male: female) and an age range of 6 to 77 years. Among all the patients, 109 developed AKI (29.7%), and of these patients, 85 were male (78.0%). In the 586 patients with MN, 27 (4.6%) patients developed AKI. The percentage of AKI in MCD patients was significantly higher than that in MN patients (χ2 = 41.063, P < 0.001). The percentage of AKI increased with age in the MCD patients. The percentage of AKI in patients aged 50 years or older was 52.9% (46/87), which was significantly higher than that [22.5% (63/280)] in patients under 50 years (χ2 = 6.347, P = 0.013). We observed statistically significant differences in age (43 [27, 59] years vs. 28 [20, 44] years, Z = 5.487, P < 0.001), male (78.0% vs. 51.4%, χ2 = 22.470, P < 0.001), serum albumin (19.9 ± 6.1 g/L vs. 21.5 ± 5.7 g/L, t = 2.376, P = 0.018), serum creatinine (129.5 [105.7, 171.1] μmol/L vs. 69.7 [57.7, 81.9] μmol/L, Z = 14.190, P < 0.001), serum urea (10.1 [6.2, 15.8] mmol/L vs. 4.7 [3.6, 6.4] mmol/L, Z = 10.545, P < 0.001), IgE (266.0 [86.7, 963.0] IU/ml vs. 142.0 [35.3, 516.5] IU/ml, Z = 2.742, P = 0.007), history of diabetes (6.4% vs. 1.2%, P = 0.009), and history of hypertension (23.9% vs. 5.1%, χ2 = 28.238, P < 0.001) between the AKI group and the non-AKI group. According to multivariate linear regression analysis, among the renal pathological features analyzed, renal tubular epithelial cell damage (β = 178.010, 95% CI: 147.888-208.132, P < 0.001) and renal interstitial edema (β = 28.833, 95% CI: 11.966-45.700, P = 0.001) correlated with serum creatinine values.
Conclusions:
The percentage of AKI in MCD patients is significantly higher than that in MN patients. Patients over 50 years old are more likely to develop AKI. Renal tubular epithelial cell injury and renal interstitial edema may be the main pathological lesions that are associated with elevated serum creatinine in patients with MCD.
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骨髓间充质基质细胞线粒体转移至软骨细胞对大鼠软骨退行性线粒体功能障碍的保护作用Rui Wang, Talatibaike Maimaitijuma, Yuan-Yuan Ma, Yang Jiao, Yong-Ping Cao
中华医学杂志英文版2021年 134卷 02期
DOI: 10.1097/CM9.0000000000001057
摘要
Background:
Previous studies have reported that mitochondrial dysfunction participates in the pathological process of osteoarthritis (OA). However, studies that improve mitochondrial function are rare in OA. Mitochondrial transfer from mesenchymal stem cells (MSCs) to OA chondrocytes might be a cell-based therapy for the improvement of mitochondrial function to prevent cartilage degeneration. This study aimed to determine whether MSCs can donate mitochondria and protect the mitochondrial function and therefore reduce cartilage degeneration.
Methods:
Bone-marrow-derived mesenchymal stromal cells (BM-MSCs) were harvested from the marrow cavities of femurs and tibia in young rats. OA chondrocytes were gathered from the femoral and tibial plateau in old OA model rats. BM-MSCs and OA chondrocytes were co-cultured and mitochondrial transfer from BM-MSCs to chondrocytes was identified. Chondrocytes with mitochondria transferred from BM-MSCs were selected by fluorescence-activated cell sorting. Mitochondrial function of these cells, including mitochondrial membrane potential (Δψm), the activity of mitochondrial respiratory chain (MRC) enzymes, and adenosine triphosphate (ATP) content were quantified and compared to OA chondrocytes without mitochondrial transfer. Chondrocytes proliferation, apoptosis, and secretion ability were also analyzed between the two groups.
Results:
Mitochondrial transfer was found from BM-MSCs to OA chondrocytes. Chondrocytes with mitochondrial from MSCs (MSCs + OA group) showed increased mitochondrial membrane potential compared with OA chondrocytes without mitochondria transfer (OA group) (1.79 ± 0.19 vs. 0.71 ± 0.12, t = 10.42, P < 0.0001). The activity of MRC enzymes, including MRC complex I, II, III, and citrate synthase was also improved (P < 0.05). The content of ATP in MSCs + OA group was significantly higher than that in OA group (161.90 ± 13.49 vs. 87.62 ± 11.07 nmol/mg, t = 8.515, P < 0.0001). Meanwhile, we observed decreased cell apoptosis (7.09% ± 0.68% vs.15.89% ± 1.30%, t = 13.39, P < 0.0001) and increased relative secretion of type II collagen (2.01 ± 0.14 vs.1.06 ± 0.11, t = 9.141, P = 0.0008) and proteoglycan protein (2.08 ± 0.20 vs. 0.97 ± 0.12, t = 8.227, P = 0.0012) in MSCs + OA group, contrasted with OA group.
Conclusions:
Mitochondrial transfer from BM-MSCs provided protection for OA chondrocytes against mitochondrial dysfunction and degeneration through improving mitochondrial function, cell proliferation, and inhibiting apoptosis in chondrocytes. This finding may offer a new therapeutic direction for OA.
Clinical Observation
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在急性A型主动脉夹层的主动脉弓修复术中，停循环期间不需要镇静剂Alexander O. Makkinejad, Jeffrey ClemenceJr, Elizabeth L. Norton, Linda Farhat, Xiao-Ting Wu, Daniel H. Ferman, Bo Yang
中华医学杂志英文版2021年 134卷 02期
DOI: 10.1097/CM9.0000000000001248
摘要
急性A型主动脉夹层(ATAAD)开放主动脉弓手术期间最大限度地保护脑的标准方案通常包括两种围手术期策略的组合，包括低温循环停止(HCA)和脑灌注联合药物（例如，巴比妥类)作为额外脑保护的辅助药物。[
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人体器官转运绿色通道提高中国公民捐献肺利用率：单中心数据分析Xiao-Shan Li, Chun-Xiao Hu, Feng Liu, Jian Huang, Dong Liu, Zhi-Hui Yu, Hui-Xing Li, Jin Zhao, Qian-Li Ma, Jing-Yu Chen
中华医学杂志英文版2021年 134卷 02期
DOI: 10.1097/CM9.0000000000001325
摘要
致编辑：公民逝世后器官捐献计划于2015年在我国全面启动。根据捐献器官的分配规定，所有捐献的肺必须通过中国器官移植反应系统（COTRS，www.cot.org.cn）进行分配。[
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支架象鼻全弓置换术治疗梅毒性胸主动脉瘤Yang-Feng Tang, Lin Han, Zhi-Yun Xu
中华医学杂志英文版2021年 134卷 02期
DOI: 10.1097/CM9.0000000000000993
摘要
在抗生素治疗出现后，在过去几十年中很少观察到三期梅毒，其心血管表现尤其罕见。梅毒性主动脉炎通常累及升主动脉、主动脉弓和降胸主动脉的管状部分，不累及瓦尔萨尔瓦窦。[
Technical Note
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中复杂性肾癌腹腔镜肾部分切除术闭合技术的改进Qi-Wei Yang, Xiu-Wu Pan, Jian-Qing Ye, Chuan-Min Chu, Fa-Jun Qu, Lin Li, Wei Yang, Lei Wang, Si-Shun Gan, Xin-Gang Cui
中华医学杂志英文版2021年 134卷 02期
DOI: 10.1097/CM9.0000000000001052
摘要
腹腔镜肾部分切除术（LPN）作为一种微创保留肾单位的手术，正逐渐成为T1a肾癌的首选手术治疗，因为它产生更快的术后恢复和与根治性肾切除术相当的肿瘤学结果。[
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腹膜外单孔机器人辅助前列腺癌根治术的初步体会Yi-Fan Chang, Di Gu, Ni Mei, Wei-Dong Xu, Xiao-Jun Lu, Yu-Tian Xiao, Chuan-Liang Xu, Ying-Hao Sun, Shan-Cheng Ren
中华医学杂志英文版2021年 134卷 02期
DOI: 10.1097/CM9.0000000000001145
摘要
在过去的几十年里，根治性前列腺切除术（RP）的手术范围已经从开放手术发展到新的微创方法，机器人辅助根治性前列腺切除术（RARP）被普遍认为是前列腺癌（PCa）越来越受欢迎的选择。先前的一项研究证明了根治性辅助腹腔镜根治性前列腺切除术（RALP）的安全性和有效性。[
Rapid Report
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性别决定区Y-box 2阳性肺泡细胞对博莱霉素诱导的肺损伤有反应Xue Li, Yong-Mei Wang, An Wang, Yue Li, Qi Wu, Huai-Yong Chen
中华医学杂志英文版2021年 134卷 02期
DOI: 10.1097/CM9.0000000000001086
摘要
肺泡上皮作为重要的屏障，在肺气体交换和宿主防御中起着重要作用。肺泡上皮主要由紧密连接以维持肺泡上皮完整性的肺泡I型(AT1)和II型(AT2)细胞组成。有几种干细胞/祖细胞能够响应于各种损伤修复成人肺泡上皮。Kim及其同事鉴定了能够分化为肺泡细胞和气道细胞的支气管肺泡干细胞（BASCs）。[
Correspondence
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肺肝样腺癌伴全身多发转移Jing-Xian Chen, Ling-Ling Lyu, Wen-Hua Zhu, Xiao-Yan Chen, Lan Zheng
中华医学杂志英文版2021年 134卷 02期
DOI: 10.1097/CM9.0000000000000963
摘要
致编辑：肺肝样腺癌（HAL）是一种罕见的恶性肿瘤，可定义为产生甲胎蛋白（AFP）的原发性肺癌。大多数肝样腺癌（HAC）具有高AFP表达。HAL缺乏有效治疗方法，预后较差，但早期诊断和及时治疗可提高长期生存率。
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吸入豚鼠过敏原致过敏反应Rui Tang, Hong Li
中华医学杂志英文版2021年 134卷 02期
DOI: 10.1097/CM9.0000000000000971
摘要
致编辑：27岁男性，因喘息，伴有咳嗽入院北京协和医院；白痰；呼吸困难；打喷嚏；流鼻涕、鼻塞和发痒的鼻子眼睛发红发痒；双臂上有风团；腹痛头晕。他的症状在他给豚鼠洗澡并擦干后10分钟开始出现。西替利嗪和类固醇当日部分缓解症状，至次日晨完全缓解。患者病史包括过敏性鼻炎和湿疹，无食物或药物过敏。他父亲对奶酪和鸡蛋过敏。他养了一只猫20年，一只狗5年，一只豚鼠2年。入院查体发现双腿散在斑丘疹、抓痕、结痂，鼻黏膜苍白水肿，肺部呼吸音清晰。他被诊断患有过敏反应、过敏性鼻炎和湿疹。进行过敏原检测。皮肤试验对尘螨（++）、灰尘（+）和猫（++）呈阳性。他的总IgE为200 kU/L。血清特异性IgE(sIgE)结果显示如下：Phadiatop，11.4 pharmacia任意单位/L(3级)；豚鼠(e6)，22.7 kU过敏原(A)/L(4级)；屋尘螨(d1)，10.6 kU(A)/L(3级)；粉尘螨(d2)，11.4 kU(A)/L(3级)；hx2(h2，d1，d2，i6)，12.7 kU(A)/L(3级)；和猫皮屑(e1)，0.89 kU(A)/L(2级)。仓鼠(e84)、大鼠(e87)、小鼠(e88)、狗皮屑(e5)的sIgE值，烟曲霉(m3)，和交链格孢（m6）都是<0.35 kU（A）/L（Immuno-CAP，赛默飞世尔科技公司，圣何塞，加利福尼亚州，美国）。肺功能检查为1 s用力呼气量（FEV1），88%；FEV1/用力容积肺活量，114%；和呼出的一氧化氮分数，98 ppb。
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武汉最大方舱医院1327例2019冠状病毒病（COVID-19）患者的临床特征Chong Lu, Han-Yu Wang, Xiao Chen, Zi-Ling Wu, Shan Meng, Wei He, Kai-Song Xu, Xin-Qiao Fu, Yu Hu, Chao Yang 等
中华医学杂志英文版2021年 134卷 02期
DOI: 10.1097/CM9.0000000000001194
摘要
致编辑：冠状病毒疾病2019（新冠肺炎）是严重急性呼吸综合征冠状病毒2（新型冠状病毒）感染的结果，具有高度传染性。[
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转移核糖核酸（赖氨酸）中变异m.8363G>A导致的不对称顶叶和颞叶萎缩Josef Finsterer
中华医学杂志英文版2021年 134卷 02期
DOI: 10.1097/CM9.0000000000001118
摘要
致编辑：我们饶有兴趣地阅读了徐的文章等人[
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“连合下降”接线技术便于导管穿越严重狭窄的主动脉瓣Yu Du, Paul Sorajja, Miho Fukui, Go Hashimoto, Aisha Ahmed, Mario Gössl
中华医学杂志英文版2021年 134卷 02期
DOI: 10.1097/CM9.0000000000001142
摘要
致编辑：患者男，82岁，症状性严重钙化性主动脉瓣狭窄（峰值速度：5.19 m/s；平均梯度：78.0 mmHg；主动脉瓣面积：0.48 cm2）行经股动脉经导管主动脉瓣置换术。在手术过程中，使用由6 Fr Judkins Right 4（JR4）冠状动脉导管（Medtronic，Minneapolis，MN，USA）支撑的0.035英寸直尖滑动丝（Terumo，Somerset，NJ，USA）穿过严重狭窄的主动脉瓣。然而，JR4导管无法通过主动脉瓣，因为导丝在左/右冠状动脉连合处穿过主动脉瓣，产生了不利的角度和导管的可推动性有限。我们没有改用不同形状的导管（如Amplatz left 1导管），而是将滑动导丝推进，从而使导丝的支撑性更强的部分进一步穿过主动脉瓣。随后，导丝和JR4导管均落入非/左冠状动脉连合处，允许JR4导管轻松穿过瓣膜。最终，植入了34 mm自膨胀Evolut R瓣膜（Medtronic），患者顺利出院（
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肺炎性脑室炎合并脑室脓肿1例Yong-Gang Gui, Yan-Fen Chai, Song-Tao Shou, Chen-Guang Zhao
中华医学杂志英文版2021年 134卷 02期
DOI: 10.1097/CM9.0000000000001203
摘要
致编辑：脑室炎，也称为室管膜炎、脑室脓胸、脓头或化脓性脑室炎，是脑室室管膜衬里的炎症。脑室引流系统的炎症通常继发于脑脊液的细菌感染。据报道，高达45%的患者患有脑室炎。[
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基于体素的帕金森病伴步态冻结脑微结构扩散指数变化分析Jing-Wu Chen, Fa-Ze Mai, Yong-Zhe Yang, Wan-Qun Yang, Li-Juan Wang, Kun Nie, Biao Huang
中华医学杂志英文版2021年 134卷 02期
DOI: 10.1097/CM9.0000000000001042
摘要
致编辑：步态冻结（FOG）是帕金森病（PD）中常见的致残运动障碍，影响约50%至80%的晚期PD患者。雾会导致患者容易跌倒，严重影响他们的生活质量，并施加经济和情感负担。与PD的常见运动症状（如运动迟缓、震颤或强直）不同，FOG很少通过多巴胺能药物治疗或深部脑刺激得到改善。此外，FOG可能对左旋多巴有抗性（或甚至因左旋多巴而恶化）。[
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先天性肝膈疝1例报告Hou-Gan Ouyang, Zhi-Dong Zhao, Wen-Jing Lu, Hui-Ting Wu
中华医学杂志英文版2021年 134卷 02期
DOI: 10.1097/CM9.0000000000001164
摘要
致编辑：作者在一名身高约170厘米的中年男性标本中发现疑似先天性肝膈疝。具体报告如下。标本平放，常规解剖方法打开胸腔和腹腔。接着又惊奇地发现，肝右叶大部分穿过膈肌内的主动脉裂孔，穿过右肺斜裂疝进入胸腔，造成右肺下叶严重挤压变形，继而发育不良。周围亦可见胆囊及墨绿色胆汁，肝左叶仍在腹腔内[
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