MedNexus
2021年 · 第134卷第12期
出版日期 2021-06-20电子版 ￥0.00元
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Editorial
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银屑病关节炎诊断和治疗的多学科团队Yu-Xin Zheng, Min Zheng
中华医学杂志英文版2021年 134卷 12期
DOI: 10.1097/CM9.0000000000001588
摘要
银屑病关节炎（PsA）是银屑病的一种特殊亚型，严重影响患者的生活质量。PsA的临床表现多种多样。除皮肤病变外，PsA患者还常有与皮肤病变同时或相继发生的肌肉骨骼症状、指甲改变和眼科特征。[
Consensus Statement
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超声引导下真空辅助乳腺活检临床实践指南：中国乳腺外科学会（CSBrS）实践指南2021Si-Jie Li, Xiao-Peng Hao, Bin Hua, Jian-Dong Wang, Zhi-Min Fan, Chinese Society of Breast Surgery
中华医学杂志英文版2021年 134卷 12期
DOI: 10.1097/CM9.0000000000001508
摘要
超声引导下真空辅助乳腺活检（VABB）是乳腺外科的常用技术。为了规范该技术，中国乳腺外科学会（CSBrS）参考建议评估、开发和评估的分级，根据《超声引导真空辅助乳腺活检手术专家共识和操作指南（2017）》结合中国乳腺外科临床实践数据，重新评估了VABB临床研究的证据质量，并制定了《超声引导真空辅助乳腺活检临床实践指南：CSBrS实践指南2021》，为中国乳腺外科医生提供参考。
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超声引导乳腺病变和淋巴结活检临床实践指南：中国乳腺外科学会（CSBrS）实践指南2021Jin-Fei Ma, Lu-Yan Chen, Shuang-Ling Wu, Ying-Ying Xu, Fan Yao, Feng Jin, Pei-Fen Fu, Bo Chen, Chinese Society of Breast Surgery
中华医学杂志英文版2021年 134卷 12期
DOI: 10.1097/CM9.0000000000001549
摘要
随着影像引导穿刺活检技术的成熟和进步，开放乳腺活检的比例逐渐降低。超声引导活检在实践中方便，支持实时可视化。为规范超声引导乳腺及区域淋巴结活检的实践，为中国乳腺外科医生提供参考，基于超声引导乳腺病变及淋巴结活检共识声明及操作指南（2019）版，[
Review Article
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中国肠易激综合征的流行病学、诊断和治疗进展Yi-Lin Liu, Jin-Song Liu
中华医学杂志英文版2021年 134卷 12期
DOI: 10.1097/CM9.0000000000001550
摘要
Irritable bowel syndrome (IBS) is a common functional gastrointestinal disease worldwide. Current guidelines of IBS are mostly based on the western populations and expected to vary in different communities. China has a large population and a vast literature is available on IBS. Due to linguistic variations in the literature, the studies are not widely known and their conclusions thus remain largely obscured to the western medical literature. In this article, we reviewed the published literatures on the investigations of IBS epidemiology, diagnosis, and management in the Chinese population and emphasized the different findings gleaned from the western publications. The detailed literature review will benefit understanding of and promote future study on IBS.
Viewpoint
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动脉粥样硬化性肾动脉狭窄：我们该怎么办？Ying Jiang, Ming-Hua Zhang
中华医学杂志英文版2021年 134卷 12期
DOI: 10.1097/CM9.0000000000001576
摘要
动脉粥样硬化性肾动脉狭窄（ARAS）是肾血管疾病和进行性疾病的常见形式。它可能导致顽固性高血压和肾功能不全。它几乎与缺血性肾病伴肾功能进行性下降和心脏并发症包括短暂性肺水肿有关。ARAS的存在也与心血管死亡风险增加相关。ARAS的常见治疗策略包括药物治疗和支架置入血管成形术。
Original Article
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影响首次卵巢过度刺激累积活产率的相关因素分析体外受精或卵胞浆内单精子注射周期：一项来自中国17,978名女性的基于人群的研究Rui Yang, Zi-Ru Niu, Li-Xue Chen, Ping Liu, Rong Li, Jie Qiao
中华医学杂志英文版2021年 134卷 12期
DOI: 10.1097/CM9.0000000000001586
摘要
Background:
More and more scholars have called for the cumulative live birth rate (CLBR) of a complete ovarian stimulation cycle as a key indicator for assisted reproductive technology. This research aims to study the CLBR of the first ovarian hyperstimulation cycles and analyze the related prognosis factors that might affect the CLBR.
Methods:
Our retrospective study included first in vitro fertilization or intracytoplasmic sperm injection (IVF/ICSI) cycles performed between January 2013 to December 2014. A total of 17,978 couples of first ovarian hyperstimulation IVF/ICSI cycles were included. The study was followed up for 4 years to observe the CLBR. The multivariable logistic regression model was used to analyze the prognosis factor, P value of <0.05 was considered statistically significant.
Results:
The cumulative pregnancy rate was 58.14% (10,452/17,978), and the CLBR was 49.66% (8928/17,978). The female age was younger in the live birth group when compared with the non-live birth group (30.81 ± 4.05 vs. 33.09 ± 5.13, P < 0.001). The average duration of infertility was shorter than the non-live birth cohort (4.22 ± 3.11 vs. 5.06 ± 4.08, P < 0.001). The preliminary gonadotropin used and the total number of gonadotropin used were lower in the live birth group when compared with the non-live birth group (both P < 0.001). Meanwhile, the number of oocytes retrieved and transferrable embryos were both significantly higher in the live birth group (15.35 ± 7.98 vs. 11.35 ± 7.60, P < 0.001; 6.66 ± 5.19 vs. 3.62 ± 3.51, P < 0.001, respectively).
Conclusions:
The women’s age, body mass index, duration of infertility years, infertility factors, controlled ovarian hyperstimulation protocol, the number of acquired oocytes, and number of transferrable embryos are the prognosis factors that significantly affected the CLBR.
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影响初始无呼叫结果后第二次无创产前筛查成功率的两个因素：来自中国单个三级中心的经验Ying Lin, Dong Liang, Hang Li, Chun-Yu Luo, Ping Hu, Zheng-Feng Xu
中华医学杂志英文版2021年 134卷 12期
DOI: 10.1097/CM9.0000000000001531
摘要
Background:
One inevitable shortcoming of non-invasive prenatal screening (NIPS)/cell-free DNA (cfDNA) sequencing is the uninterpretable ( "no-call" ) result, which is mainly caused by an insufficient fetal fraction. This study was performed to investigate the factors associated with a successful second NIPS in these cases and determine the optimal management for women with initial no-call results.
Methods:
We retrospectively analyzed the data of women who underwent NIPS with initial no-call results due to an insufficient fetal fraction from 2017 to 2019 in our center. We compared these women’s maternal and pregnancy information with the data of women who had attained a successful second NIPS result and women who had received no-call results for a second time.
Results:
Among the 33,684 women who underwent NIPS, 137 with a no-call result underwent a retest. Comparison between the 87 (63.50%) women with a successful retest and the other 50 (36.50%) women showed a significant difference in both the initial fetal fraction and maternal body mass index (BMI), whereas the other factors showed no significant differences. In addition, with an initial fetal fraction of < 2.00%, the retest success rate was very limited.
Conclusions:
We identified two major factors associated with a successful NIPS retest: the initial fetal fraction and the maternal BMI. These findings suggest the need for specialized management for this subset of women and would be instructional for the counseling for these women.
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我国食管癌高发区功能性消化不良的流行病学和临床特征Nan Hu, Kun Wang, Li Zhang, Zuo-Jing Liu, Zhu Jin, Rong-Li Cui, He-Jun Zhang, Zhong-Hu He, Yang Ke, Li-Ping Duan
中华医学杂志英文版2021年 134卷 12期
DOI: 10.1097/CM9.0000000000001584
摘要
Background:
Functional dyspepsia (FD) has rarely been investigated in areas with a high prevalence of esophageal squamous cell carcinoma (ESCC). This study aims to reveal the epidemiological and clinical features of FD and organic dyspepsia (OD) in such a population.
Methods:
A middle-aged and elderly population-based study was conducted in a region with a high incidence of ESCC. All participants completed the Gastroesophageal Reflux Disease Questionnaire and Functional Gastrointestinal Disease Rome III Diagnostic Questionnaire, and they underwent gastroscopy. After exclusion of gastroesophageal reflux disease, uninvestigated dyspepsia (UID) was divided into OD and FD for further analyses.
Results:
A total of 2916 participants were enrolled from July 2013 to March 2014 in China. We detected 166 UID cases with questionnaires, in which 17 patients with OD and 149 with FD were diagnosed via gastroscopy. OD cases presented as reflux esophagitis (RE), ESCC, and duodenal ulcer. Heartburn (52.94%) and reflux (29.41%) were common in OD, but no symptomatic differences were found between FD and OD. Male sex, low education level, and liquid food were the risk factors for OD, while frequent fresh vegetable consumption was a protective factor. FD included 56 (37.58%) cases of postprandial distress syndrome (PDS), 52 (34.89%) of epigastric pain syndrome (EPS), nine (6.04%) of PDS + EPS, and 32 (21.48%) of FD + functional esophageal disorders. The Helicobacter pylori infection rate in FD patients was not higher than that in the control group (34.23% vs. 42.26%, P = 0.240). Frequent spicy food consumption was associated with PDS (odds ratio [OR]: 2.088, 95% confidence interval [CI]: 1.028-4.243), while consumption of deep well water was protective for PDS (OR: 0.431, 95% CI: 0.251-0.741).
Conclusions:
The prevalence of FD was 5.11% in the studied population. Gastroscopy should be prescribed for dyspepsia patients in case that ESCC and RE would be missed in UID cases diagnosed solely by the Rome III questionnaire.
Trial Registration:
ClinicalTrials.gov, NCT01688908; https://clinicaltrials.gov/ct2/show/record/NCT01688908.
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既往有造血细胞移植史的患者心脑血管疾病风险增加Bo Peng, Li-Li Wang, Li-Ping Dou, Fei Li, Xiang-Shu Jin, Lu Wang, Ming-Yu Jia, Yan Li, Jian Bo, Yu Zhao 等
中华医学杂志英文版2021年 134卷 12期
DOI: 10.1097/CM9.0000000000001569
摘要
Background:
The impacts of previous cardio-cerebrovascular disease (pre-CCVD) on the outcomes of hematopoietic cell transplantation (HCT) are not well described. Patients with pre-CCVD may often be poor candidates for HCT. This study aimed to investigate the impact of pre-CCVD on transplant outcomes.
Methods:
A retrospective study was conducted between patients with and without pre-CCVD who consecutively received allogeneic or autologous HCT between November 2013 and January 2020 with a matching of age and disease status. The cardiovascular complications and HCT outcomes of the two groups were evaluated and compared. The primary endpoints were post-transplant cardio-cerebrovascular disease (post-CCVD) and non-relapse mortality (NRM). We used a multivariable Cox proportional hazard model and the Fine-Gray competing risk regressions for analyses to estimate the hazard ratios (HRs).
Results:
The outcomes of 23 HCT recipients with pre-CCVD were compared with those of 107 patients in the control group. No significant differences were noted in terms of engraftment, overall survival (OS) (67.00% vs. 67.90%, P = 0.983), or relapse (29.78% vs. 28.26%, P = 0.561) between the pre-CCVD group and the control group. The cumulative incidences of 2-year NRM were similar between patients with pre-CCVD and the controls (14.68% vs. 17.08%, P = 0.670). However, pre-CCVD was associated with an increased incidence of post-CCVD (HR: 12.50, 95% confidence interval [CI]: 3.88-40.30, P < 0.001), which was an independent risk factor for increased NRM (HR: 10.29, 95% CI: 3.84-27.62, P < 0.001) and inferior OS (HR: 10.29, 95% CI: 3.84-27.62, P < 0.001).
Conclusions:
These findings suggest that the existence of pre-CCVD before transplantation might not result in increased mortality directly but superpose the toxicity of the transplantation procedure, leading to a risk of post-CCVD. Post-CCVD was a powerful predictor for high NRM and inferior OS. Further risk stratification of pre-CCVD is needed to reduce NRM in various transplantation settings.
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强直性脊柱炎患者的隐匿性Andersson病变：X线平片上检测不到的破坏性病变Ji-Chen Huang, Bang-Ping Qian, Yong Qiu, Bin Wang, Yang Yu, Shi-Zhou Zhao
中华医学杂志英文版2021年 134卷 12期
DOI: 10.1097/CM9.0000000000001557
摘要
Background:
Andersson lesions (ALs) are not uncommon in ankylosing spondylitis (AS). Plain radiography (PR) is widely used for the diagnosis of ALs. However, in our practice, there were some ALs in AS patients that could not be detected on plain radiographs. This study aimed to propose the concept of occult ALs and evaluate the prevalence and radiographic characteristics of the occult ALs in AS patients.
Methods:
A total of 496 consecutive AS patients were admitted in the Affiliated Drum Tower Hospital, Medical School of Nanjing University between April 2003 and November 2019 and they were retrospectively reviewed. The AS patients with ALs who met the following criteria were included for the investigation of occult ALs: (1) with pre-operative plain radiographs of the whole-spine and (2) availability of pre-operative computed tomography (CT) and/or magnetic resonance imaging (MRI) of the whole-spine. The occult ALs were defined as the ALs which were undetectable on plain radiographs but could be detected by CT and/or MRI. The extensive ALs involved the whole discovertebral junction or manifested as destructive lesions throughout the vertebral body. Independent-samples t test was used to compare the age between the patients with only occult ALs and those with only detectable ALs. Chi-square or Fisher exact test was applied to compare the types, distribution, and radiographic characteristics between detectable and occult ALs as appropriate.
Results:
Ninety-two AS patients with a mean age of 44.4 ± 10.1 years were included for the investigation of occult ALs. Twenty-three patients had occult ALs and the incidence was 25% (23/92). Fifteen extensive ALs were occult, and the proportion of extensive ALs was significantly higher in detectable ALs (97% vs. 44%, χ2 = 43.66, P < 0.001). As assessed by PR, the proportions of osteolytic destruction with reactive sclerosis (0 vs. 100%, χ2 = 111.00, P < 0.001), angular kyphosis of the affected discovertebral units or vertebral body (0 vs. 22%, χ2 = 8.86, P = 0.003), formation of an osseous bridge at the intervertebral space adjacent to ALs caused by the ossification of the anterior longitudinal ligament (38% vs. 86%, χ2 = 25.91, P < 0.001), and an abnormal height of the affected intervertebral space were all significantly lower in occult ALs (9% vs. 84%, χ2 = 60.41, P < 0.001).
Conclusions:
Occult ALs presented with more subtle radiographic changes. Occult ALs should not be neglected, especially in the case of extensive occult ALs, because the stability of the spine might be severely impaired by these lesions.
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病变和血管定量血流比的临界值再一次药物涂层球囊治疗后冠状动脉病变预测中期随访血管再狭窄Pei-Na Meng, Bin Liu, Long-Bo Li, De-Lu Yin, Heng Zhang, De-Feng Pan, Wei You, Zhi-Ming Wu, Xiang-Qi Wu, Lei Zhao 等
中华医学杂志英文版2021年 134卷 12期
DOI: 10.1097/CM9.0000000000001577
摘要
Background:
Drug-coated balloons (DCBs) have emerged as potential alternatives to drug-eluting stents in specific lesion subsets for de novo coronary lesions. Quantitative flow ratio (QFR) is a method based on the three-dimensional quantitative coronary angiography and contrast flow velocity during coronary angiography (CAG), obviating the need for an invasive fractional flow reserve procedural. This study aimed to assess the serial angiographic changes of de novo lesions post-DCB therapy and further explore the cut-off values of lesion and vessel QFR, which predict vessel restenosis (diameter stenosis [DS] ≥50%) at mid-term follow-up.
Methods:
The data of patients who underwent DCB therapy between January 2014 and December 2019 from the multicenter hospital were retrospectively collected for QFR analysis. From their QFR performances, which were analyzed by CAG images at follow-up, we divided them into two groups: group A, showing target vessel DS ≥50%, and group B, showing target vessel DS <50%. The median follow-up time was 287 days in group A and 227 days in group B. We compared the clinical characteristics, parameters during DCB therapy, and QFR performances, which were analyzed by CAG images between the two groups, in need to explore the cut-off value of lesion/vessel QFR which can predict vessel restenosis. Student’s t test was used for the comparison of normally distributed continuous data, Mann-Whitney U test for the comparison of non-normally distributed continuous data, and receiver operating characteristic (ROC) curves for the evaluation of QFR performance which can predict vessel restenosis (DS ≥50%) at mid-term follow-up using the area under the curve (AUC).
Results:
A total of 112 patients with 112 target vessels were enrolled in this study. Group A had 41 patients, while group B had 71. Vessel QFR and lesion QFR were lower in group A than in group B post-DCB therapy, and the cut-off values of lesion QFR and vessel QFR in the ROC analysis to predict target vessel DS ≥50% post-DCB therapy were 0.905 (AUC, 0.741 [95% confidence interval, CI: 0.645, 0.837]; sensitivity, 0.817; specificity, 0.561; P < 0.001) and 0.890 (AUC, 0.796 [95% CI: 0.709, 0.882]; sensitivity, 0.746; specificity, 0.780; P < 0.001).
Conclusions:
The cut-off values of lesion QFR and vessel QFR can assist in predicting the angiographic changes post-DCB therapy. When lesion/vessel QFR values are <0.905/0.890 post-DCB therapy, a higher risk of vessel restenosis is potentially predicted at follow-up.
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一项双盲、双模拟、随机对照、多中心试验99Tc-亚甲基二膦酸盐治疗中重度类风湿性关节炎Qiong Fu, Ping Feng, Ling-Yun Sun, Xiao-Xia Zuo, Dong-Bao Zhao, Dong-Yi He, Hua-Xiang Wu, Wei Zhang, Wei Zhang, Fang Du 等
中华医学杂志英文版2021年 134卷 12期
DOI: 10.1097/CM9.0000000000001527
摘要
Background:
Clinical observational studies revealed that 99Tc-methylene diphosphonate (99Tc-MDP) could reduce joint pain and swollenness in rheumatoid arthritis (RA) patients. This multicenter, randomized, double-blind, double-dummy study aimed to evaluate the effects of 99Tc-MDP plus methotrexate (MTX) vs. MTX alone or 99Tc-MDP alone on disease activity and structural damage in MTX-naïve Chinese patients with moderate to severe RA.
Methods:
Eligible patients with moderate to severely active RA were randomized to receive 99Tc-MDP plus MTX (n = 59) vs. MTX (n = 59) alone or 99Tc-MDP (n = 59) alone for 48 weeks from six study sites across four provinces in China. The primary outcomes were the American College of Rheumatology 20% improvement (ACR20) response rates at week 24 and changes in modified total Sharp score at week 48.
Results:
At week 24, the proportion of participants achieving ACR20 was significantly higher in the MTX+ 99Tc-MDP combination group (69.5%) than that in the MTX group (50.8%) or 99Tc-MDP group (47.5%) (P = 0.03 for MTX+ 99Tc-MDP vs. MTX, and MTX+ 99Tc-MDP vs.99Tc-MDP, respectively). The participants in the MTX+ 99Tc-MDP group and the 99Tc-MDP group had significantly less important radiographic progression than the participants in the MTX group over the 48 weeks (MTX + 99Tc-MDP vs. MTX: P = 0.03, 99Tc-MDP vs. MTX: P = 0.03, respectively). There was no significant difference in terms of adverse events (AEs) among the groups. No serious AEs were observed.
Conclusions:
This study demonstrated that the combination of 99Tc-MDP with MTX inhibited structural damage and improved disease activity in RA patients compared with MTX and 99Tc-MDP monotherapies, without increasing the rate of AEs. Additional clinical studies of 99Tc-MDP therapy in patients with RA are warranted.
Trial Registration:
Chictr.org, ChiCTR-IPR-14005684; http://www.chictr.org.cn/showproj.aspx?proj=10088.
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中国类风湿性关节炎登记：IV.中国类风湿性关节炎疾病活动指数的相关性和一致性Xing Song, Yan-Hong Wang, Meng-Tao Li, Xin-Wang Duan, Hong-Bin Li, Xiao-Feng Zeng, the Co-authors of CREDIT
中华医学杂志英文版2021年 134卷 12期
DOI: 10.1097/CM9.0000000000001517
摘要
Background:
Disease activity indices (DAIs) including disease activity score 28 (DAS28), simplified disease activity index (SDAI), and clinical disease activity index (CDAI) have been widely used in clinical practice and research studies of rheumatoid arthritis (RA). The objective of our study was to evaluate the correlation and concordance among different DAIs in Chinese patients with RA.
Methods:
A cross-sectional study, including patients enrolled in the Chinese registry of rheumatoid arthritis from November 2016 to August 2018, was conducted. The correlations were evaluated using Spearman correlation coefficient and concordance with Bland-Altman plots, quadratic weighted kappa, and discordance rates in the crosstab. For other indices, the optimal cutoff points corresponding to SDAI remission were explored through receiver operating characteristic curve analysis.
Results:
A total of 30,501 patients were included, of whom 80.46% were women. Most individuals were with moderate disease activity or high disease activity. High correlations among DAS28-erythrocyte sedimentation rate (ESR) and DAS28-C-reactive protein (CRP), SDAI and CDAI were observed. Similarly, the weighted kappa value among the indices was high. In Bland-Altman plots, a positive difference between DAS28-ESR and DAS28-CRP was observed, with an absolute difference of >1.2 in 3079 (10.09%) patients. In crosstab, approximately 30% of the patients were classified into different groups. Concordance values between SDAI remission and the optimal cutoff points of DAS28-ESR, DAS28-CRP, and CDAI were 3.06, 2.37, and 3.20, respectively.
Conclusions:
Although DAIs had high correlations and weighted kappa values, the discordance between DAIs was significant in Chinese patients with RA. The four DAIs are not interchangeable.
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使用FDA不良事件报告系统数据库评估紫杉烷相关不良事件Dong-Hui Lao, Ye Chen, Jun Fan, Jian-Zhong Zhang
中华医学杂志英文版2021年 134卷 12期
DOI: 10.1097/CM9.0000000000001562
摘要
Background:
Taxanes are an essential class of antineoplastic agents used to treat various cancers and are a fundamental cause of hypersensitivity reactions. In addition, other adverse events, such as bone marrow toxicity and peripheral neuropathy, can lead to chemotherapy discontinuation. This study aimed to evaluate the safety of taxanes in the real world.
Methods:
Taxane-associated adverse events were identified by the Medical Dictionary for Regulatory Activities Preferred Terms and analyzed and compared by mining the US Food and Drug Administration Adverse Event Reporting System pharmacovigilance database from January 2004 to December 2019. Reported adverse events, such as hypersensitivity reaction, bone marrow toxicity, and peripheral neuropathy, were analyzed with the following signal detection algorithms: reporting odds ratio (ROR), proportional reporting ratio (PRR), multi-item gamma Poisson shrinker (MGPS), Bayesian confidence propagation neural network (BCPNN), and logistic regression methods. Adverse outcome events and death outcome rates were compared between different taxane groups using Pearson’s χ2 test, whereas significance was determined at P < 0.05 with a 95% confidence interval (CI).
Results:
A total of 966 reports of hypersensitivity reactions, 1109 reports of bone marrow toxicity, and 1374 reports of peripheral neuropathy were analyzed. Compared with paclitaxel and docetaxel, bone marrow toxicity following the use of nab-paclitaxel had the highest ROR of 6.45 (95% two-sided CI, 6.05-6.88), PRR of 5.66, (χ2 = 4342.98), information component of 2.50 (95% one-sided CI = 2.34), and empirical Bayes geometric mean of 5.64 (95% one-sided CI = 5.34). Peripheral neuropathy following the use of nab-paclitaxel showed a higher ROR of 12.78 (95% two-sided CI, 11.55-14.14), PRR of 12.16 (χ2 = 4060.88), information component of 3.59 (95% one-sided CI = 3.25), and empirical Bayes geometric mean of 12.07 (95% one-sided CI = 11.09).
Conclusions:
The results showed that bone marrow toxicity and peripheral neuropathy were the major adverse events induced by taxanes. Nab-paclitaxel exhibited the highest potential for taxane-associated adverse events. Further research in the future is warranted to explain taxane-associated adverse effects in real-world circumstances.
Clinical Observation
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地西他滨联合小剂量阿糖胞苷、阿柔比星和粒细胞集落刺激因子与标准治疗急性髓系白血病患者的疗效和安全性比较TP53突变Si-Si Chen, Qian Sun, Lan Cao, Wen-Zhong Wu, Yue Xie, Chun Qiao, Jian-Yong Li, Si-Xuan Qian, Ming Hong
中华医学杂志英文版2021年 134卷 12期
DOI: 10.1097/CM9.0000000000001316
摘要
肿瘤抑制基因P53(TP53）是一个关键的肿瘤抑制基因。突变型p53蛋白增强了肿瘤细胞的活性、侵袭和转移。急性髓系白血病（AML）患者TP53突变对常规化疗反应差，临床结局差。我们之前在老年AML患者中进行了一项多中心II期临床试验（编号ChiCTRONC-11001700），联合地西他滨、小剂量阿糖胞苷、阿柔比星、粒细胞集落刺激因子（G-CSF）（DCAG方案），显示总缓解率（ORR）为82.4%，完全缓解（CR）率为64.7%。[
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异基因造血干细胞移植术后出血性膀胱炎手术干预因素的多因素分析Wen-Bo Yang, Yi-Qing Du, Wen-Jun Bai, Lu-Ping Yu, Xiao-Peng Zhang, Qi Wang, Xiao-Wei Zhang, Qing Li, Tao Xu
中华医学杂志英文版2021年 134卷 12期
DOI: 10.1097/CM9.0000000000001295
摘要
出血性膀胱炎(HC)的特征在于脉管系统充血和膀胱固有层广泛出血，通常继发于化疗、外部放射治疗、异基因造血干细胞移植(Allo-HSCT)和/或机会性感染。[
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中的新突变B3GALNT2中国人α-营养不良聚糖病的致病基因Xiao-Yu Chen, Dan-Yu Song, Yan-Bin Fan, Dan-Dan Tan, Xing-Zhi Chang, Jiang-Xi Xiao, Tatsushi Toda, Hui Xiong
中华医学杂志英文版2021年 134卷 12期
DOI: 10.1097/CM9.0000000000001283
摘要
α-营养不良聚糖病（α-DGP）是先天性肌营养不良（CMDs）的一种亚型，具有常染色体隐性遗传。其主要发病机制是α-肌营养不良聚糖（α-DG）翻译后O-糖基化缺陷。α-DGP表现出广泛的临床谱，从最严重的CMD如Walker-Warburg综合征(WWS)、肌眼脑病(MEB)和Fukuyama先天性肌营养不良到最轻微的肢带肌营养不良。TheB3GALNT2（NM 152490）是α-DGP的致病基因之一。它编码一种产生独特碳水化合物结构的酶，硝基乙酰半乳糖胺-β-1, 3-硝基乙酰葡糖胺（GalNAc-β-1-3GlcNAc），该结构对α-DG的O-糖基化至关重要。[
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激光散斑对比成像预测星状神经节阻滞成功Xi Wu, Jun-Wei Xia, Shang-Long Yao, Ning An
中华医学杂志英文版2021年 134卷 12期
DOI: 10.1097/CM9.0000000000001398
摘要
星状神经节阻滞（SGB）在用于治疗疼痛综合征时非常有益，包括面部急性带状疱疹、带状疱疹后神经痛和交感神经介导的头部疼痛。由于判断模糊和主观，霍纳综合征作为成功SGB的传统指标并不可靠。[
Technical Notes
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使用定制开窗的现成胸主动脉内修复主动脉支架进行患者特异性全主动脉弓腔内修复Yu Shen, Kak Khee Yeung, Qing-Sheng Lu
中华医学杂志英文版2021年 134卷 12期
DOI: 10.1097/CM9.0000000000001438
摘要
医生改良的开窗覆膜支架用于胸主动脉腔内修复术（TEVAR）具有经济优势，可用于主动脉夹层和累及主动脉弓的动脉瘤的急性情况。[
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下斜肌腹转位治疗小角度不对称上斜肌麻痹疗效分析Yu Su, Cheng-Yue Zhang, Dan-Dan Wang, Shi-Qiang Yang
中华医学杂志英文版2021年 134卷 12期
DOI: 10.1097/CM9.0000000000001591
摘要
不对称上斜肌麻痹（SOP）是一种复杂的、非伴随的斜视类型。患者通常表现为患眼小角度肥大，伴有下斜肌过度活动（IOOA）。[
Rapid Report
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慢性疲劳综合征、体位性心动过速综合征和发作性睡病与5，10-亚甲基四氢叶酸还原酶的共病（MTHFR)青少年突变1例Ying Liao, Jian-Guang Qi, Hui Yan, Qing-You Zhang, Tao-Yun Ji, Xing-Zhi Chang, Hai-Po Yang, Hong-Fang Jin, Jun-Bao Du
中华医学杂志英文版2021年 134卷 12期
DOI: 10.1097/CM9.0000000000001387
摘要
一名16岁男性青少年因间歇性头晕、嗜睡和疲劳住院约2年。患者发热、咽痛发作，持续近2周，出现上述症状前因急性阑尾炎行阑尾切除术。他主要在早上起床时从仰卧位转换为直立位后出现严重头晕。头晕症状通常持续数分钟至数小时，平卧可部分缓解。此外，尽管每天的总睡眠时间为14至15小时，但他一整天都感到困倦和疲劳。所有症状可通过完全卧床休息1或2周而部分缓解，但他在再次参加正常学校生活后复发。此外，劳累或感染后疲劳感明显加重。他无法专心学习，不得不长期休学。结果发病后学习成绩下降。他曾经受益于服用肉碱和叶酸；然而，在使他能够参加正常的社会和学校生活方面，改善有限。他在宣讲前身心健康，没有对过去的学习产生反感。无明显的心血管或神经系统疾病家族史。该研究由北京大学第一医院伦理委员会批准（编号：2020-415）。
Correspondence
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我国小儿抗N-甲基-D-天冬氨酸受体脑炎治疗策略综述Xiao-Shuang Cao, Miriam Kessi, Tao-Yun Ji, Yu-Wu Jiang, Fei Yin, Jing Peng
中华医学杂志英文版2021年 134卷 12期
DOI: 10.1097/CM9.0000000000001308
摘要
致编辑：目前，儿科抗-N-甲基-D-天冬氨酸受体(NMDAR)。卡恩有两项调查等人[
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中国无睡眠呼吸障碍儿童腺样体发育模式：一项连续年龄组的回顾性磁共振成像研究Xiao-Li Yi, Lin-Yin Yao, Peng-Fei Zhao, Xin-Yu Yuan, Zhen-Chang Wang
中华医学杂志英文版2021年 134卷 12期
DOI: 10.1097/CM9.0000000000001478
摘要
致编辑：睡眠呼吸障碍(SDB)是影响中国约12%儿童的健康问题，[
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丘疹性弹性破裂的皮肤镜检查Jia-Qing Zhao, Zhe Xu, Bin Wang, Yan-Jia Li, Guo-Qiang Zhang
中华医学杂志英文版2021年 134卷 12期
DOI: 10.1097/CM9.0000000000001280
摘要
致编辑：丘疹性弹性破裂（PE）是一种罕见的获得性弹性组织疾病。其病因和发病机制尚不清楚。PE好发于躯干和四肢，临床上表现为儿童和青少年多发性无症状、3~5mm非滤泡肉色丘疹，主要见于女性。它仅表现为皮肤受累，大多数患者无症状，经常被误诊和不治疗。在此，我们提出了一个PE病例，并描述了其以前没有报道过的皮肤镜特征。
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腹部硬纤维瘤复发的临床病理特征及预后因素：来自中国两家医院的113例患者的回顾性研究Si-Cheng Zhou, Wei Pei, Zhen Sun, Zhi-Xiang Zhou, Xi-Shan Wang, Jian-Wei Liang, Qiang Feng
中华医学杂志英文版2021年 134卷 12期
DOI: 10.1097/CM9.0000000000001333
摘要
致编辑：硬纤维瘤（DTs）表现出对周围结构的局部侵袭性，并表现出复发的倾向，导致高的局部复发率和显著的功能损伤和发病率。[
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肛门生殖器区域丘疹性棘层溶解性角化不良伴新发ATP2C1基因突变Xue-Min Xiao, Yi-Qun Jiang, Wei Tian, Cheng-Rang Li
中华医学杂志英文版2021年 134卷 12期
DOI: 10.1097/CM9.0000000000001443
摘要
致编辑：局灶性棘层溶解性角化不良（FAD）用于描述一组临床表现多样但组织学结构特征性的疾病。1984年，报道了第一例“外阴脚区丘疹性棘层溶解性角化不良（PAD）”，患者为一名23岁女性，病理表现为FAD，研究者认为这可能是一种新的独立疾病。[
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粘膜下注射生理盐水治疗结肠内翻性憩室的临床研究Jeonghun Lee, Youngsun Kim
中华医学杂志英文版2021年 134卷 12期
DOI: 10.1097/CM9.0000000000001485
摘要
致编辑：结肠憩室病是世界范围内常见的结肠疾病，与西方患者不同，主要见于亚洲患者的右半结肠。倒置结肠憩室（ICD）不太常见，在约0.7%的结肠镜检查中观察到。由于ICD常与结肠息肉相似，因此很难通过结肠镜鉴别。因此，活检或内窥镜切除后的肠穿孔可能是一种严重的并发症。描述的有助于诊断ICD的结肠镜检查操作包括放射枕头征、使用空气吹入和水射流以及用镊子翻转ICD。极光环，最近被描述为病变周围的同心苍白环，也可以帮助诊断ICD，而不需要操作。本报告描述了通过粘膜下盐水注射接受内镜操作的病例。这项临床试验的结果可能有助于区分ICD和结肠息肉。
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