MedNexus
2021年 · 第134卷第06期
出版日期 2021-03-20电子版 ￥0.00元
MedNexus
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- Editorial
- Review Article
- Meta-Analysis
- Perspective
- Original Article
- Clinical Observation
- Technical Notes
- Correspondence
- Corrigendum
Editorial
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睡眠障碍和急性卒中：概况和研究机会Xiang Fu, Shou-Jiang You, Jie Li, Chun-Feng Liu
中华医学杂志英文版2021年 134卷 06期
DOI: 10.1097/CM9.0000000000001426
摘要
中风是全世界残疾和死亡的主要原因。超过一半的脑卒中患者有睡眠障碍，包括睡眠呼吸障碍、非呼吸暂停睡眠障碍和昼夜节律紊乱。因此，睡眠障碍，特别是阻塞性睡眠呼吸暂停（OSA），长期以来被推测为中风的新的预防和治疗靶点。上述睡眠障碍在卒中结局中的具体作用或持续气道正压通气（CPAP）治疗OSA预防脑血管事件的疗效仍不确定。值得注意的是，这些研究存在重要的局限性。在这里，我们简要回顾了代表性研究，随后主要讨论了临床研究的机会。最后概述了主要建议。
Review Article
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光疗法：神经退行性疾病的新选择Yu-Lu Liu, Si-Yi Gong, Shu-Ting Xia, Ya-Li Wang, Hao Peng, Yun Shen, Chun-Feng Liu
中华医学杂志英文版2021年 134卷 06期
DOI: 10.1097/CM9.0000000000001301
摘要
Given the increasing incidence of neurodegenerative disease (ND), recent research efforts have intensified the search for curative treatments. Despite significant research, however, existing therapeutic options for ND can only slow down the progression of the disease, but not provide a cure. Light therapy (LT) has been used to treat some mental and sleep disorders. This review illustrates recent studies of the use of LT in patients with ND and highlights its potential for clinical applications. The literature was collected from PubMed through June 2020. Selected studies were primarily English articles or articles that could be obtained with English abstracts and Chinese main text. Articles were not limited by type. Additional potential publications were also identified from the bibliographies of identified articles and the authors’ reference libraries. The identified literature suggests that LT is a safe and convenient physical method of treatment. It may alleviate sleep disorders, depression, cognitive function, and other clinical symptoms. However, some studies have reported limited or no effects. Therefore, LT represents an attractive therapeutic approach for further investigation in ND. LT is an effective physical form of therapy and a new direction for research into treatments for ND. However, it requires further animal experiments to elucidate mechanisms of action and large, double-blind, randomized, and controlled trials to explore true efficacy in patients with ND.
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脑淀粉样血管病相关炎症：现状和未来意义Juan-Juan Wu, Ming Yao, Jun Ni
中华医学杂志英文版2021年 134卷 06期
DOI: 10.1097/CM9.0000000000001427
摘要
Cerebral amyloid angiopathy-related inflammation (CAA-RI) is a rare but increasingly recognized subtype of CAA. CAA-RI consists of two subtypes: inflammatory cerebral amyloid angiopathy and amyloid β (Aβ)-related angiitis. Acute or subacute onset of cognitive decline or behavioral changes is the most common symptom of CAA-RI. Rapid progressive dementia, headache, seizures, or focal neurological deficits, with patchy or confluent hyperintensity on T2 or fluid-attenuated inversion recovery sequences and evidence of strictly lobar microbleeds or cortical superficial siderosis on susceptibility-weighted imaging imply CAA-RI. The gold standard for diagnosis is autopsy or brain biopsy. However, biopsy is invasive; consequently, most clinically diagnosed cases have been based on clinical and radiological data. Other diagnostic indexes include the apolipoprotein E ε4 allele, Aβ and anti-Aβ antibodies in cerebral spinal fluid and amyloid positron emission tomography. Many diseases with similar clinical manifestations should be carefully ruled out. Immunosuppressive therapy is effective both during initial presentation and in relapses. The use of glucocorticoids and immunosuppressants improves prognosis. This article reviews the pathology and pathogenesis, clinical and imaging manifestations, diagnostic criteria, treatment, and prognosis of CAA-RI, and highlights unsolved problems in the existing research.
Meta-Analysis
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血清胆红素浓度与帕金森病关系的meta分析Jia-Ning Jin, Xian Liu, Ming-Juan Li, Xin-Ling Bai, An-Mu Xie
中华医学杂志英文版2021年 134卷 06期
DOI: 10.1097/CM9.0000000000001300
摘要
Background:
The antioxidant effects of bilirubin in Parkinson’s disease (PD) have recently gained much attention from the research community. However, results from these studies have been conflicting. This meta-analysis is conducted to assess the relationship between the serum bilirubin concentration and the risk of PD.
Methods:
Two reviewers performed a systematic literature search across five databases (MEDLINE, PubMed, EMBASE, Web of Science, and Cochrane Central Register of Controlled Trials). The case-control studies regarding bilirubin levels in PD patients published up to April 2020 were included. These studies were subjected to rigorous scrutiny and data extraction to determine the standard mean difference (SMD) and the 95% confidence interval (CI), which were analyzed using the Stata V.12.0 statistical software.
Results:
A total of eight studies which included 1463 PD cases and 1490 controls were incorporated into our meta-analysis. SMD analysis showed that there was a higher total bilirubin (TBIL) and direct bilirubin (DBIL) levels in PD patients compared with controls (for TBIL, SMD: 0.300, 95% CI: 0.050-0.549, P = 0.018; for DBIL, SMD: 0.395, 95% CI: 0.102-0.688, P = 0.008). However, no significant relationship was found between the serum indirect bilirubin and PD patients (SMD: -0.223, 95% CI: -0.952-0.505, P = 0.548). A subgroup analysis based on ethnicity indicated that the serum TBIL was higher in PD patients of Caucasian descent in contrast to matched healthy controls (SMD: 0.511, 95% CI: 0.324-0.698, P = 0.000, I2 = 58.0%).
Conclusion:
Higher serum bilirubin levels in PD patients suggest that bilirubin might play a role in the pathogenesis of PD and have the potential to be utilized as a biochemical marker for PD diagnosis and treatment.
Perspective
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作为阿尔茨海默病潜在电生物标志物的脑电图和睡眠结构的变化Hang Yu, Man-Li Wang, Xiao-Lan Xu, Rong Zhang, Wei-Dong Le
中华医学杂志英文版2021年 134卷 06期
DOI: 10.1097/CM9.0000000000001394
摘要
阿尔茨海默病（AD）是一种以痴呆和精神疾病为特征的神经退行性疾病。AD的主要病理变化是β淀粉样蛋白（A β）和磷酸化tau的堆积。随着人口老龄化的增加，中国≥60岁成年人的患病率将从5.4%（2015年）增长至6.7%（2050年）。[
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原发性进行性失语症非流利/语法变异体的神经影像学及遗传学研究进展Yi-Jing Bai, Xiao-Wei Liu, Wei-Dong Le
中华医学杂志英文版2021年 134卷 06期
DOI: 10.1097/CM9.0000000000001424
摘要
原发性进行性失语症(PPA)通常是指神经退行性疾病，例如额颞叶变性(FTLD)或阿尔茨海默病(AD)，其特征在于控制语言的大脑系统逐渐丧失，其他认知领域相对保留。[
Original Article
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帕金森病患者疲劳与睡眠障碍的相关性Xiang-Yang Cao, Jin-Ru Zhang, Yun Shen, Cheng-Jie Mao, Yu-Bing Shen, Yu-Lan Cao, Han-Ying Gu, Fen Wang, Chun-Feng Liu
中华医学杂志英文版2021年 134卷 06期
DOI: 10.1097/CM9.0000000000001303
摘要
Background:
Many Parkinson disease (PD) patients complain about chronic fatigue and sleep disturbances during the night. The objective of this study is to determine the relationship between fatigue and sleep disturbances by using polysomnography (PSG) in PD patients.
Methods:
Two hundred and thirty-two PD patients (152 with mild fatigue and 80 with severe fatigue) were recruited in this study. Demographic information and clinical symptoms were collected. Fatigue severity scale (FSS) was applied to evaluate the severity of fatigue, and PSG was conducted in all PD patients. FSS ≥4 was defined as severe fatigue, and FSS <4 was defined as mild fatigue. Multivariate logistic regression and linear regression models were used to investigate the associations between fatigue and sleep disturbances.
Results:
Patients with severe fatigue tended to have a longer duration of disease, higher Unified Parkinson Disease Rating Scale score, more advanced Hoehn and Yahr stage, higher daily levodopa equivalent dose, worse depression, anxiety, and higher daytime sleepiness score. In addition, they had lower percentage of rapid eye movement (REM) sleep (P = 0.009) and were more likely to have REM sleep behavior disorder (RBD) (P = 0.018). Multivariate logistic regression analyses found that the presence of RBD and proportion of REM sleep were the independent predictors for fatigue. After the adjustment of age, sex, duration, body mass index, severity of disease, scores of Hamilton Rating Scale for Depression, Hamilton Anxiety Rating Scale, and other sleep disorders, proportion of REM sleep and degree of REM sleep without atonia in patients with PD were still associated with FSS score.
Conclusion:
Considering the association between fatigue, RBD, and the altered sleep architecture, fatigue is a special subtype in PD and more studies should be focused on this debilitating symptom.
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贫血和失眠：一项横断面研究和荟萃分析Samantha N. Neumann, Jun-Juan Li, Xiao-Dong Yuan, Shuo-Hua Chen, Chao-Ran Ma, Laura E. Murray-Kolb, Yun Shen, Shou-Ling Wu, Xiang Gao
中华医学杂志英文版2021年 134卷 06期
DOI: 10.1097/CM9.0000000000001306
摘要
Background:
Several recent genome-wide association studies suggested insomnia and anemia may share some common genetic components. We thus examined whether adults with anemia had higher odds of having insomnia relative to those without anemia in a cross-sectional study and a meta-analysis.
Methods:
Included in this cross-sectional study were 12,614 Chinese adults who participated in an ongoing cohort, the Kailuan Study. Anemia was defined as hemoglobin levels below 12.0 g/dL in women and 13.0 g/dL in men. Insomnia was assessed using the Chinese version of the Athens Insomnia Scale (AIS). A total AIS score ≥6 was considered insomnia. The association between anemia and insomnia was assessed using a logistic regression model, adjusting for potential confounders such as age, sex, chronic disease status, and plasma C-reactive protein concentrations. A meta-analysis was conducted using the fixed effects model to pool results from our study and three previously published cross-sectional studies on this topic in adult populations.
Results:
Individuals with anemia had greater odds of having insomnia (adjusted odds ratio [OR]: 1.32; 95% confidence interval [CI]: 1.03-1.70) compared with individuals without anemia. A significant association persisted after we excluded individuals with chronic inflammation, as suggested by C-reactive protein levels >1 mg/L (adjusted OR: 1.68; 95% CI: 1.22-2.32). The meta-analysis results, including 22,134 participants, also identified a positive association between anemia and insomnia (pooled OR: 1.39; 95% CI: 1.22-1.57).
Conclusions:
The presence of anemia was significantly associated with a higher likelihood of having insomnia in adults. Due to the nature of the cross-sectional study design, results should be interpreted with caution.
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中性粒细胞与淋巴细胞比值是动脉瘤性蛛网膜下腔出血患者术后肺炎的预后因素Yue Chen, Bao-Qiang Lian, Lei Peng, Chen-Yu Ding, Yuan-Xiang Lin, Liang-Hong Yu, Deng-Liang Wang, De-Zhi Kang
中华医学杂志英文版2021年 134卷 06期
DOI: 10.1097/CM9.0000000000001304
摘要
Background:
Although a variety of risk factors of pneumonia after clipping or coiling of the aneurysm (post-operative pneumonia [POP]) in patients with aneurysmal subarachnoid hemorrhage (aSAH) have been studied, the predictive model of POP after aSAH has still not been well established. Thus, the aim of this study was to assess the feasibility of using admission neutrophil to lymphocyte ratio (NLR) to predict the occurrence of POP in aSAH patients.
Methods:
We evaluated 711 aSAH patients who were enrolled in a prospective observational study and collected admission blood cell counts data. We analyzed available demographics and baseline variables for these patients and analyzed the correlation of these factors with POP using Cox regression. After screening out the prognosis-related factors, the predictive value of these factors for POP was further assessed.
Results:
POP occurred in 219 patients (30.4%) in this cohort. Patients with POP had significantly higher NLR than those without (14.11 ± 8.90 vs. 8.80 ± 5.82, P < 0.001). Multivariate analysis revealed that NLR remained a significant factor independently associated with POP following aSAH after adjusting for possible confounding factors, including the age, World Federation of Neurosurgical Societies (WFNS) grade, endovascular treatment, and ventilator use. And the predictive value of NLR was significantly increased after WFNS grade was combined with NLR (NLR vs. WFNS grade × NLR, P = 0.011).
Conclusions:
Regardless of good or poor WNFS grade, patients having NLR >10 had significantly worse POP survival rate than patients having NLR ≤10. NLR at admission might be helpful as a predictor of POP in aSAH patients.
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多系统萎缩的睡眠相关症状：决定因素及对疾病严重程度的影响Jun-Yu Lin, Ling-Yu Zhang, Bei Cao, Qian-Qian Wei, Ru-Wei Ou, Yan-Bing Hou, Kun-Cheng Liu, Xin-Ran Xu, Zheng Jiang, Xiao-Jing Gu 等
中华医学杂志英文版2021年 134卷 06期
DOI: 10.1097/CM9.0000000000001211
摘要
Background:
Sleep disorders are common but under-researched symptoms in patients with multiple system atrophy (MSA). We investigated the frequency and factors associated with sleep-related symptoms in patients with MSA and the impact of sleep disturbances on disease severity.
Methods:
This cross-sectional study involved 165 patients with MSA. Three sleep-related symptoms, namely Parkinson’s disease (PD)-related sleep problems (PD-SP), excessive daytime sleepiness (EDS), and rapid eye movement sleep behavior disorder (RBD), were evaluated using the PD Sleep Scale-2 (PDSS-2), Epworth Sleepiness Scale (ESS), and RBD Screening Questionnaire (RBDSQ), respectively. Disease severity was evaluated using the Unified MSA Rating Scale (UMSARS).
Results:
The frequency of PD-SP (PDSS-2 score of ≥18), EDS (ESS score of ≥10), and RBD (RBDSQ score of ≥5) in patients with MSA was 18.8%, 27.3%, and 49.7%, respectively. The frequency of coexistence of all three sleep-related symptoms was 7.3%. Compared with the cerebellar subtype of MSA (MSA-C), the parkinsonism subtype of MSA (MSA-P) was associated with a higher frequency of PD-SP and EDS, but not of RBD. Binary logistic regression revealed that the MSA-P subtype, a higher total UMSARS score, and anxiety were associated with PD-SP; that male sex, a higher total UMSARS score, the MSA-P subtype, and fatigue were associated with EDS; and that male sex, a higher total UMSARS score, and autonomic onset were associated with RBD in patients with MSA. Stepwise linear regression showed that the number of sleep-related symptoms (PD-SP, EDS, and RBD), disease duration, depression, fatigue, and total Montreal Cognitive Assessment score were predictors of disease severity in patients with MSA.
Conclusions:
Sleep-related disorders were associated with both MSA subtypes and the severity of disease in patients with MSA, indicating that sleep disorders may reflect the distribution and degree of dopaminergic/non-dopaminergic neuron degeneration in MSA.
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骨髓间充质干细胞在氧葡萄糖剥夺/恢复条件下通过磷酸肌醇3-激酶/蛋白激酶B/血红素加氧酶-1信号通路调节RAW 264.7巨噬细胞的自噬Ning-Fang Wang, Chun-Xue Bai
中华医学杂志英文版2021年 134卷 06期
DOI: 10.1097/CM9.0000000000001133
摘要
Background:
Autophagy of alveolar macrophages is a crucial process in ischemia/reperfusion injury-induced acute lung injury (ALI). Bone marrow-derived mesenchymal stem cells (BM-MSCs) are multipotent cells with the potential for repairing injured sites and regulating autophagy. This study was to investigate the influence of BM-MSCs on autophagy of macrophages in the oxygen-glucose deprivation/restoration (OGD/R) microenvironment and to explore the potential mechanism.
Methods:
We established a co-culture system of macrophages (RAW264.7) with BM-MSCs under OGD/R conditions in vitro. RAW264.7 cells were transfected with recombinant adenovirus (Ad-mCherry-GFP-LC3B) and autophagic status of RAW264.7 cells was observed under a fluorescence microscope. Autophagy-related proteins light chain 3 (LC3)-I, LC3-II, and p62 in RAW264.7 cells were detected by Western blotting. We used microarray expression analysis to identify the differently expressed genes between OGD/R treated macrophages and macrophages co-culture with BM-MSCs. We investigated the gene heme oxygenase-1 (HO-1), which is downstream of the phosphoinositide 3-kinase/protein kinase B (PI3K/Akt) signaling pathway.
Results:
The ratio of LC3-II/LC3-I of OGD/R treated RAW264.7 cells was increased (1.27 ± 0.20 vs. 0.44 ± 0.08, t = 6.67, P < 0.05), while the expression of p62 was decreased (0.77 ± 0.04 vs. 0.95 ± 0.10, t = 2.90, P < 0.05), and PI3K (0.40 ± 0.06 vs. 0.63 ± 0.10, t = 3.42, P < 0.05) and p-Akt/Akt ratio was also decreased (0.39 ± 0.02 vs. 0.58 ± 0.03, t = 9.13, P < 0.05). BM-MSCs reduced the LC3-II/LC3-I ratio of OGD/R treated RAW264.7 cells (0.68 ± 0.14 vs. 1.27 ± 0.20, t = 4.12, P < 0.05), up-regulated p62 expression (1.10 ± 0.20 vs. 0.77 ± 0.04, t = 2.80, P < 0.05), and up-regulated PI3K (0.54 ± 0.05 vs. 0.40 ± 0.06, t = 3.11, P < 0.05) and p-Akt/Akt ratios (0.52 ± 0.05 vs. 0.39 ± 0.02, t = 9.13, P < 0.05). A whole-genome microarray assay screened the differentially expressed gene HO-1, which is downstream of the PI3K/Akt signaling pathway, and the alteration of HO-1 mRNA and protein expression was consistent with the data on PI3K/Akt pathway.
Conclusions:
Our results suggest the existence of the PI3K/Akt/HO-1 signaling pathway in RAW264.7 cells under OGD/R circumstances in vitro, revealing the mechanism underlying BM-MSC-mediated regulation of autophagy and enriching the understanding of potential therapeutic targets for the treatment of ALI.
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基于下一代测序的食管鳞癌基因突变研究Long Wang, Yi-Meng Jia, Jing Zuo, Yu-Dong Wang, Zhi-Song Fan, Li Feng, Xue Zhang, Jing Han, Wen-Jing Lyu, Zhi-Yu Ni
中华医学杂志英文版2021年 134卷 06期
DOI: 10.1097/CM9.0000000000001411
摘要
Background:
Esophageal squamous cell carcinoma (ESCC) is one of the most aggressive cancers without effective therapy. To explore potential molecular targets in ESCC, we quantified the mutation spectrum and explored the relationship between gene mutation and clinicopathological characteristics and programmed death-ligand 1 (PD-L1) expression.
Methods:
Between 2015 and 2019, 29 surgically resected ESCC tissues and adjacent normal tissues from the Fourth Hospital of Hebei Medical University were subjected to targeted next-generation sequencing. The expression levels of PD-L1 were detected by immunohistochemistry. Mutational signatures were extracted from the mutation count matrix by using non-negative matrix factorization. The relationship between detected genomic alterations and clinicopathological characteristics and PD-L1 expression was estimated by Spearman rank correlation analysis.
Results:
The most frequently mutated gene was TP53 (96.6%, 28/29), followed by NOTCH1 (27.6%, 8/29), EP300 (17.2%, 5/29), and KMT2C (17.2%, 5/29). The most frequently copy number amplified and deleted genes were CCND1/FGF3/FGF4/FGF19 (41.4%, 12/29) and CDKN2A/2B (10.3%, 3/29). By quantifying the contribution of the mutational signatures to the mutation spectrum, we found that the contribution of signature 1, signature 2, signature 10, signature 12, signature 13, and signature 17 was relatively high. Further analysis revealed genetic variants associated with cell cycle, chromatin modification, Notch, and Janus kinase-signal transducer and activator of transcription signaling pathways, which may be key pathways in the development and progression of ESCC. Evaluation of PD-L1 expression in samples showed that 13.8% (4/29) of samples had tumor proportion score ≥1%. 17.2% (5/29) of patients had tumor mutation burden (TMB) above 10 mut/Mb. All samples exhibited microsatellite stability. TMB was significantly associated with lymph node metastasis (r = 0.468, P = 0.010), but not significantly associated with PD-L1 expression (r = 0.246, P = 0.198). There was no significant correlation between PD-L1 expression and detected gene mutations (all P > 0.05).
Conclusion:
Our research initially constructed gene mutation profile related to surgically resected ESCC in high-incidence areas to explore the mechanism underlying ESCC development and potential therapeutic targets.
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初步脂肪去除不能预防小鼠饮食诱导的代谢紊乱Lin Liu, Chen-Xi Liang, Xiao-Wei Wang, Ke-Xin Pei, Xin-Di Ma, Chun-Xi Zhang, Jing-Hui Dong, Ming-Ming Gao, Jia-Wei Liao
中华医学杂志英文版2021年 134卷 06期
DOI: 10.1097/CM9.0000000000001334
摘要
Background:
Obesity is a fundamental factor in metabolic disorders such as hyperlipidemia, insulin resistance, fatty liver, and atherosclerosis. However, effective preventive measures are still lacking. This study aimed to investigate different surgical protocols for removing partial adipose tissue before the onset of obesity and determine whether, and by which protocol, preliminary adipose removal could exert potent preventive effects against diet-induced metabolic disorders.
Methods:
Male low-density lipoprotein receptor (LDL-R) knockout (KO) mice were randomly divided into four groups and subjected to epididymal fat removal (Epi-FR) surgery, subcutaneous fat removal (suQ-FR) surgery, both subcutaneous and epididymal fat removal (Epi + suQ-FR) surgery, or sham-operation. After 1 week of recovery, all mice were given a high-fat diet (HFD) for 10 weeks to induce metabolic disorders.
Results:
In the Epi-FR group and the sham-operated group, the mean numbers of the residual subcutaneous fat were 28.59 mg/g and 18.56 mg/g, respectively. The expression of relative genes such as Pparg, Cebpa, Dgat2, Fabp4 and Cd36 in the residual subcutaneous fat increased 2.62, 3.90, 3.11, 2.06, 1.78 times in the Epi-FR group compared with that in the sham-operated group. Whereas in the other fat-removal groups, the residual fat depots had no significant change in either size or gene expression, as compared with those of the sham-operated group. Plasma lipid and glucose levels and insulin sensitivity, as detected by the glucose tolerance test, were not significantly alleviated in the three fat removal groups. Liver mass or lipid content was not attenuated in any of the three fat removal groups. The atherosclerosis burdens in the entire inner aorta and aortic root did not decrease in any of the three fat removal groups.
Conclusions:
Our data suggest that removal of epididymal adipose or subcutaneous adipose alone or in combination before the onset of obesity did not protect against hyperlipidemia, insulin resistance, fatty liver, or atherosclerosis in LDL-R KO mice fed with a HFD. Hence, adipose removal possibly does not represent a potential approach in preventing obesity-related metabolic disorders in the obesity-susceptible population.
Clinical Observation
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社区居民肌肉减少症与认知障碍的关系Hui Zhu, Heng-Dong Li, Bei-Li Feng, Lu Zhang, Zai-Xing Zheng, Yue Zhang, Dong-Juan Wang, Zi Xiong, Jun-Fei Kang, Jia-Chang Jin 等
中华医学杂志英文版2021年 134卷 06期
DOI: 10.1097/CM9.0000000000001310
摘要
认知障碍是一种神经退行性改变，涉及从轻度认知障碍到痴呆的进展。[
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全身炎症反应指数可改善脑膜瘤切除术后肺炎的预测Yue Chen, Yuan-Xiang Lin, Yue Pang, Jian-He Zhang, Jian-Jun Gu, Gao-Qi Zhang, Liang-Hong Yu, Zhang-ya Lin, De-Zhi Kang, Chen-Yu Ding 等
中华医学杂志英文版2021年 134卷 06期
DOI: 10.1097/CM9.0000000000001298
摘要
脑膜瘤是中枢神经系统常见的肿瘤，[
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经阴道超声预测人绒毛膜促性腺激素注射当天卵泡发育和卵母细胞成熟的研究Xia Chen, Xiao-Wen Liang, Jing-Hui Fang, Zhi-Yi Chen
中华医学杂志英文版2021年 134卷 06期
DOI: 10.1097/CM9.0000000000001341
摘要
卵母细胞的质量与妊娠结局密切相关体外受精（IVF）。在卵母细胞成熟过程中，人绒毛膜促性腺激素（hCG）可以模拟黄体生成素峰值的作用，进一步加速卵泡的成熟。注射hCG的正确时机是取回高质量卵母细胞的决定性因素。[
Technical Notes
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超声引导区域麻醉中的单操作者技术Shuai Tang, Jin-Lei Li, Yu-Guan Zhang, Yu-Guang Huang
中华医学杂志英文版2021年 134卷 06期
DOI: 10.1097/CM9.00000000000011861
摘要
在超声引导的局部麻醉期间，操作者通常一只手握住探针，另一只手握住针。同时，经常需要另一个人来控制注射器。然而，在许多情况下，例如手术室高峰时间和非高峰时间，第二双手的可用性可能具有挑战性。此外，不熟悉操作员或程序的助手可能会使看似简短的程序变得冗长，从而由于沟通不畅而导致延迟甚至不良事件。已经有专家提出了不同的解决方案来解决这个问题。[
Correspondence
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运动神经元病合并肿瘤患者的临床特点Yuan Li, Lu Chen, Nan Zhang, Dong-Sheng Fan
中华医学杂志英文版2021年 134卷 06期
DOI: 10.1097/CM9.0000000000001207
摘要
致编辑：运动神经元病（MND）是一种累及上下运动神经元和锥体束的进行性、致死性神经退行性疾病。目前，MND的病因尚不清楚，治疗策略有限。副肿瘤综合征（PNS）是一种罕见的MND模拟综合征。已有不同类型癌症患者出现MND样临床症状的报道，包括乳腺癌、肺癌和淋巴瘤。流行病学研究得出了不同的结论，一些研究表明部位特异性癌症与肌萎缩侧索硬化（ALS）发病风险之间没有关系，而另一些研究发现，在ALS病例中，任何部位癌症的总体风险都显著降低。[
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腹膜后腹腔镜根治性肾切除术中腹膜撕裂是否应该修复？Jing-Fei Teng, Jun-Feng Du, Feng Gao, Ya-Wei Guan, Xing Ai
中华医学杂志英文版2021年 134卷 06期
DOI: 10.1097/CM9.0000000000000991
摘要
致编辑：根据欧洲泌尿外科协会肾细胞癌指南，腹腔镜根治性肾切除术（LRN）是无法通过肾部分切除术治疗的T2肿瘤和局限性肿块患者的标准护理。[
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洗涤微生物群移植治疗溃疡性结肠炎患者复发性真菌感染Xia Wu, Bo-Ta Cui, Fa-Ming Zhang
中华医学杂志英文版2021年 134卷 06期
DOI: 10.1097/CM9.0000000000001212
摘要
致编辑：长期使用抗真菌药物会破坏真菌群落的平衡，使真菌感染的治疗更加困难，加重患者的结肠炎。粪便微生物群移植(FMT)在减少念珠菌抑制肠道真菌群诱导的促炎免疫获得了新的认识。[
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一名患有特纳综合征和杜氏肌营养不良症的中国女孩：这种“双重诊断”的诊断和管理Jia-Jia Chen, Bing-Yan Cao, Chang Su, Min Liu, Di Wu, Wen-Jing Li, Chun-Xiu Gong
中华医学杂志英文版2021年 134卷 06期
DOI: 10.1097/CM9.0000000000001159
摘要
致编辑：特纳综合征（TS）和杜氏肌营养不良症（DMD）的巧合极其罕见，尽管两者都是性染色体非整倍体和神经肌肉疾病。我们报告了一例患有TS和DMD的中国女孩，并回顾了文献中报道的7例病例。
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北京地区不同病因上消化道出血的独特气象特征Yue Yuan, Rui-Jia Wang, Zhen Liu, Ying-Xin Gao, Xin-Juan Liu, Jian-Yu Hao
中华医学杂志英文版2021年 134卷 06期
DOI: 10.1097/CM9.0000000000001156
摘要
致编辑：上消化道出血（UGIB）是从口腔到Treitz韧带的出血。气候条件影响许多疾病的发生，因为气象因素的变化可能影响血压[
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西藏高海拔地区社区获得性肺炎的临床和病原学特征Qucuo Meilang, Ran Li, Xue-Mei Wu, Ying Shang, Pu Ning, Jing Bao, Qiongda Bianba, Zhuoga Pubu, Li-Ping Huang, Zhan-Cheng Gao
中华医学杂志英文版2021年 134卷 06期
DOI: 10.1097/CM9.0000000000001166
摘要
致编辑：社区获得性肺炎（CAP）是最常见的传染病之一，发病率和死亡率都很高。高海拔地区的特点是气压低、紫外线辐射增加、湿度低的缺氧环境。缺氧会扰乱免疫系统的正常稳态，尤其是损害T淋巴细胞的功能，导致对细菌感染的易感性增加。高原CAP的呼吸道症状与高原肺水肿相似。但CAP的发生可加重高原肺水肿。世界范围内报道的高海拔成人CAP的公开数据很少。西藏地处平均海拔3000 m以上，缺乏高海拔地区CAP的临床和病因学资料。中国几乎所有全国性的CAP流行病学研究都排除了高海拔地区（>2500 m）。目前，西藏和低海拔地区的CAP管理策略没有差异，临床实践中应用了类似的CAP指南。[
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中国人工关节年度数据报告Bin Feng, Wei Zhu, Yan-Yan Bian, Xiao Chang, Kai-Yuan Cheng, Xi-Sheng Weng
中华医学杂志英文版2021年 134卷 06期
DOI: 10.1097/CM9.0000000000001196
摘要
致编辑：人工关节置换是治疗各种原因引起的髋关节和膝关节终末期关节病最有效的方法，已在世界范围内普及。[
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微柱阵列表面通过粘着斑激酶相关信号促进转化生长因子β 1诱导的A549细胞上皮向间充质转化Lun-Kun Ma, Xing Wang, Xiao-Li Xu, Jin Zhou, Yi Liao, Jian-Guo Feng, Li-Ling Tang
中华医学杂志英文版2021年 134卷 06期
DOI: 10.1097/CM9.0000000000001139
摘要
致编辑：基底刚性和形貌是两个重要的生物力学因素，可以调节癌细胞的生物学行为，如上皮向间充质转化（EMT）。目前，虽然研究已经开始关注机械微环境如何决定多种细胞的命运，但机械微环境影响EMT的机制仍不清楚。
Corrigendum
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勘误表：乳腺癌免疫学和免疫治疗：靶向程序性细胞死亡蛋白-1/程序性细胞死亡蛋白配体-1中华医学杂志英文版2021年 134卷 06期
DOI: 10.1097/CM9.0000000000001392
摘要
在《乳腺癌免疫学和免疫疗法：靶向程序性细胞死亡蛋白-1/程序性细胞死亡蛋白配体-1》一文中。133，第7期，第853页中华医学杂志,[
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