MedNexus
2021年 · 第134卷第15期
出版日期 2021-08-05电子版 ￥0.00元
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Consensus Statement
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非产褥期乳腺炎患者诊疗临床实践指南：中国乳腺外科学会（CSBrS）实践指南2021Fei Zhou, Xing-Chen Shang, Xing-Song Tian, Zhi-Gang Yu, Chinese Society of Breast Surgery
中华医学杂志英文版2021年 134卷 15期
DOI: 10.1097/CM9.0000000000001532
摘要
术语非产褥期乳腺炎（NPM）是指发生于非产褥期妇女的一组原因不明的良性乳腺疾病。主要病理类型为导管周围性乳腺炎（PDM）和肉芽肿性小叶性乳腺炎（GLM）。NPM的主要临床表现为乳腺肿块和乳腺脓肿。晚期可形成相关的瘘管、鼻窦或溃疡；这些往往是持续的，无法愈合。这些疾病的自然病程约为9至12个月，并且经常复发。目前没有标准的治疗方法。为了帮助临床医生做出正确的诊断并制定适当的治疗计划，中国乳腺外科学会审查了已发表的报告并进行了专家之间的讨论，以确定将纳入NPM临床实践指南的关键问题。本小组还研究了建议评估的分级、发展和评估系统，评估了相关证据，并制定了以下NPM诊断和治疗的临床实践指南（2021版），旨在为乳腺临床医生提供参考标准。
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可视化经皮乳腺组织夹临床实践指南：中国乳腺外科学会（CSBrS）实践指南2021Wu-Zhen Chen, Jing-Xin Jiang, Shan-Shan Sun, Xiu-Yan Yu, Jian Huang, Chinese Society of Breast Surgery
中华医学杂志英文版2021年 134卷 15期
DOI: 10.1097/CM9.0000000000001585
摘要
乳腺组织夹是一种在超声（US）、乳腺X线摄影（MMG）和磁共振成像（MRI）下可见的组织标记物，可用于在US或MMG引导下精确标记乳腺病变和腋窝淋巴结（LN）。[
Review Article
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桥粒蛋白与桥粒蛋白心肌病的临床表现Zhong-Yu Yuan, Li-Ting Cheng, Ze-Feng Wang, Yong-Quan Wu
中华医学杂志英文版2021年 134卷 15期
DOI: 10.1097/CM9.0000000000001581
摘要
Desmoplakin (DSP), encoded by the DSP gene, is the main desmosome component and is abundant in the myocardial tissue. There are three DSP isoforms that assume the role of supporting structural stability through intercellular adhesion. It has been found that DSP regulates the transcription of adipogenic and fibrogenic genes, and maintains appropriate electrical conductivity by regulating gap junctions and ion channels. DSP is essential for normal myocardial development and the maintenance of its structural functions. Studies have suggested that DSP gene mutations are associated with a variety of hereditary cardiomyopathy, such as arrhythmia cardiomyopathy, dilated cardiomyopathy (DCM), left ventricular noncompaction, and is also closely associated with the Carvajal syndrome, Naxos disease, and erythro-keratodermia-cardiomyopathy syndrome with skin and heart damage. The structure and function of DSP, as well as the clinical manifestations of DSP-related cardiomyopathy were reviewed in this article.
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基于程序性死亡-1/程序性死亡配体1抑制剂在非小细胞肺癌中的当前和未来药物组合策略Ying Cheng, Hui Li, Liang Zhang, Jing-Jing Liu, Chang-Liang Yang, Shuang Zhang
中华医学杂志英文版2021年 134卷 15期
DOI: 10.1097/CM9.0000000000001560
摘要
In recent years, immune checkpoint inhibitors (ICIs) have made breakthroughs in the field of lung cancer and have become a focal point for research. Programmed death-1 (PD-1) or programmed death-ligand 1 (PD-L1) inhibitor monotherapy was the first to break the treatment pattern for non-small cell lung cancer (NSCLC). However, owing to the limited benefit of ICI monotherapy at the population level and its hyper-progressive phenomenon, it may not meet clinical needs. To expand the beneficial range of immunotherapy and improve its efficacy, several research strategies have adopted the use of combination immunotherapy. At present, multiple strategies, such as PD-1/PD-L1 inhibitors combined with chemotherapy, anti-angiogenic therapy, cytotoxic T-lymphocyte-associated protein 4 inhibitors, and radiotherapy, as well as combined treatment with new target drugs, have been evaluated for clinical practice. To further understand the current status and future development direction of immunotherapy, herein, we review the recent progress of ICI combination therapies for NSCLC.
Medical Progress
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家庭肺活量测定在慢性阻塞性肺疾病自我管理中的应用Teng-Yue Zhang, Yu-Di He, Ke-Qi Chen, Yang Zhao, Yi-Xin Zhao, Kai-Feng Xu
中华医学杂志英文版2021年 134卷 15期
DOI: 10.1097/CM9.0000000000001468
摘要
据估计，每年有超过300万人死于慢性阻塞性肺病（COPD）。COPD急性加重（AECOPD）导致肺功能不可逆下降，急诊就诊、住院和住院时间增加，死亡率增加。然而，许多恶化没有报告给医疗保健专业人员进行治疗，然而这些事件虽然通常持续时间很短，但对健康状况有显著影响。[
Viewpoint
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冠状病毒疾病2019-相关肺纤维化：临床发现、发病机制和潜在治疗Ya-Le Jiang, Hua-Ping Dai, Chen Wang
中华医学杂志英文版2021年 134卷 15期
DOI: 10.1097/CM9.0000000000001464
摘要
冠状病毒疾病2019（新冠肺炎）的爆发引起了全球的关注，并造成了巨大的损失。2019新型冠状病毒，也称为严重急性呼吸综合征冠状病毒2（新型冠状病毒），与严重急性呼吸综合征（SARS）冠状病毒和中东呼吸综合征（MERS）冠状病毒具有显著的同源性。在随访研究中，62%的SARS和33%的MERS患者在出院后有肺纤维化（PF）的影像学证据，这些患者往往年龄较大，在重症监护室住院时间较长。[
Original Article
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非工作时间入院不会影响接受初次经皮冠状动脉介入治疗且首次医疗器械接触时间在90分钟内的患者的结局Wen-Jian Ma, Si-De Gao, Si-Zhuang Huang, Xu-Ze Lin, Yue-Jin Yang, Meng-Yue Yu, the Quality Control &, Improvement Center of Cardiovascular Intervention of Beijing
中华医学杂志英文版2021年 134卷 15期
DOI: 10.1097/CM9.0000000000001621
摘要
Background:
It remains unclear whether the outcomes of ST-elevation myocardial infarction (STEMI) patients treated with primary percutaneous coronary intervention (PPCI) during off-hours are as favorable as those treated during on-hours, especially those with a first medical contact-to-device (FMC-to-device) time within 90 min. We aimed to determine whether off-hours admission impacted late outcomes in patients undergoing PPCI and with an FMC-to-device time ≤90 min.
Methods:
This multicenter retrospective study included 670 STEMI patients who underwent successful PPCI and had an FMC-to-device time ≤90 min from 19 chest pain centers in Beijing from January 2018 to December 2018. Patients were divided into on-hours group and off-hours group based on their arrival time. Baseline characteristics, clinical data, and key time intervals during treatment were collected from the Quality Control & Improvement Center of Cardiovascular Intervention of Beijing by the "Heart and Brain Green Channel" app.
Results:
Overall, the median age of the patients was 58.8 years and 19.9% (133/670) were female. Of these, 296 (44.2%) patients underwent PPCI during on-hours and 374 (55.8%) patients underwent PPCI during off-hours. Compared with the on-hours group, the off-hours group had a longer FMC-to-device time and fewer patients with FMC-to-device time ≤60 min (P < 0.05). During the mean follow-up period of 24 months, a total of 64 (9.6%) participants experienced a major adverse cardiovascular event (MACE), with 28 (9.1%) in the on-hours group and 36 (9.6%) in the off-hours group (P > 0.05). According to the Cox regression analyses, off-hours admission was not a predictor of 2-year MACEs (P = 0.788). Similarly, the Kaplan-Meier curves showed that the risks of a MACE, all-cause death, reinfarction, and target vessel revascularization were not significantly different between the two groups (P > 0.05).
Conclusions:
This real-world, multicenter retrospective study demonstrated that for STEMI patients who underwent PPCI within 90 min, off-hours admission was safe, with no difference in the risk of 2-year MACEs compared with those with on-hours admission.
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北京急性心力衰竭急诊患者的长期预后和死亡率的独立预测因素：一项5年随访的多中心队列研究Yang Li, Xiao-Lu Sun, Hong Qiu, Jian Qin, Chun-Sheng Li, Xue-Zhong Yu, Guo-Xing Wang, Yan Fu, Ya-An Zheng, Bin Zhao 等
中华医学杂志英文版2021年 134卷 15期
DOI: 10.1097/CM9.0000000000001617
摘要
Background:
Acute heart failure (AHF) is the most common disease in emergency departments (EDs). However, clinical data exploring the outcomes of patients presenting AHF in EDs are limited, especially the long-term outcomes. The purposes of this study were to describe the long-term outcomes of patients with AHF in the EDs and further analyze their prognostic factors.
Methods:
This prospective, multicenter, cohort study consecutively enrolled 3335 patients with AHF who were admitted to EDs of 14 hospitals from Beijing between January 1, 2011 and September 23, 2012. Kaplan-Meier and Cox regression analysis were adopted to evaluate 5-year outcomes and associated predictors.
Results:
The 5-year mortality and cardiovascular death rates were 55.4% and 49.6%, respectively. The median overall survival was 34 months. Independent predictors of 5-year mortality were patient age (hazard ratio [HR]: 1.027, 95 confidence interval [CI]: 1.023-1.030), body mass index (BMI) (HR: 0.971, 95% CI: 0.958-0.983), fatigue (HR: 1.127, 95% CI: 1.009-1.258), ascites (HR: 1.190, 95% CI: 1.057-1.340), hepatic jugular reflux (HR: 1.339, 95% CI: 1.140-1.572), New York Heart Association (NYHA) class III to IV (HR: 1.511, 95% CI: 1.291-1.769), heart rate (HR: 1.003, 95% CI: 1.001-1.005), diastolic blood pressure (DBP) (HR: 0.996, 95% CI: 0.993-0.999), blood urea nitrogen (BUN) (HR: 1.014, 95% CI: 1.008-1.020), B-type natriuretic peptide (BNP)/N-terminal pro-B-type natriuretic peptide (NT-proBNP) level in the third (HR: 1.426, 95% CI: 1.220-1.668) or fourth quartile (HR: 1.437, 95% CI: 1.223-1.690), serum sodium (HR: 0.980, 95% CI: 0.972-0.988), serum albumin (HR: 0.981, 95% CI: 0.971-0.992), ischemic heart diseases (HR: 1.195, 95% CI: 1.073-1.331), primary cardiomyopathy (HR: 1.382, 95% CI: 1.183-1.614), diabetes (HR: 1.118, 95% CI: 1.010-1.237), stroke (HR: 1.252, 95% CI: 1.121-1.397), and the use of diuretics (HR: 0.714, 95% CI: 0.626-0.814), β-blockers (HR: 0.673, 95% CI: 0.588-0.769), angiotensin-converting enzyme inhibitors (ACEIs) (HR: 0.714, 95% CI: 0.604-0.845), angiotensin-II receptor blockers (ARBs) (HR: 0.790, 95% CI: 0.646-0.965), spironolactone (HR: 0.814, 95% CI: 0.663-0.999), calcium antagonists (HR: 0.624, 95% CI: 0.531-0.733), nitrates (HR: 0.715, 95% CI: 0.631-0.811), and digoxin (HR: 0.579, 95% CI: 0.465-0.721).
Conclusions:
The results of our study demonstrate poor 5-year outcomes of patients presenting to EDs with AHF. Age, BMI, fatigue, ascites, hepatic jugular reflux, NYHA class III to IV, heart rate, DBP, BUN, BNP/NT-proBNP level in the third or fourth quartile, serum sodium, serum albumin, ischemic heart diseases, primary cardiomyopathy, diabetes, stroke, and the use of diuretics, β-blockers, ACEIs, ARBs, spironolactone, calcium antagonists, nitrates, and digoxin were independently associated with 5-year all-cause mortality.
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中国卒中症状认知和低收入状况的地区差异对寻求紧急医疗服务的影响Jing Yuan, Guang-Liang Shan, Sheng-De Li, Chun-Peng Gao, Li-Ying Cui, Bin Peng
中华医学杂志英文版2021年 134卷 15期
DOI: 10.1097/CM9.0000000000001604
摘要
Background:
Unawareness of stroke symptoms and low income are two barriers that affect the seeking of emergency medical service (EMS). This study aimed to assess the effect of unawareness and low income on seeking EMS and to investigate the regional distribution of the unawareness and low-income status and their associations with failing to call EMS in China.
Methods:
A total of 187,723 samples from the China National Stroke Screening Survey was interviewed cross-sectionally. Four status of awareness and annual income were identified: unaware and low-income, unaware-only, low-income-only, and aware and regular income. The outcomes were whether they intended to call EMS or not. The regional distribution of each status and their associations with not calling EMS were presented.
Results:
The status of unaware and low-income, unaware-only, and low-income-only accounted for 6.3 % (11,806/187,673), 11.9% (22,241/187,673), and 21.5% (40,289/187,673) of the total sample, respectively. Not calling EMS was significantly associated with the status of unaware and low-income (odds ratio [OR]: 3.21, 95% confidence interval [CI]: 3.07-3.35), unaware-only (OR: 2.38, 95% CI: 2.31-2.46), and low-income-only (OR: 1.67, 95% CI: 1.63-1.71), compared with the aware and regular income status. The Midwest regions had higher percentages of people in the unaware and low-income status; the East, South, and Central had higher percentages of unaware-only status; the North and Northeast regions had a higher percentage of low-income-only status, compared with other regions.
Conclusion:
The existence of the regional difference in unawareness and low income justifies the specific stroke education strategies for the targeted regions and population.
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按绒毛膜性和受孕方式分层的双胞胎胎儿生长图的制定：中国的回顾性队列研究Yuan-Qing Xia, Shu-Ping Lyu, Jun Zhang, Yi-Ting Chen, Li Gao, An-Da Zhao, Yan-Lin Wang, Sheng-Hui Li
中华医学杂志英文版2021年 134卷 15期
DOI: 10.1097/CM9.0000000000001616
摘要
Background:
Twin pregnancies continue to increase worldwide; however, the current clinical prenatal evaluation for the intrauterine growth of twins still relies on the growth standards of singletons. We attempted to establish a set of fetal biometric references for Chinese twin pregnancies, stratified by chorionicity and conception mode as spontaneously conceived monochorionic diamniotic (SC-MCDA), spontaneously conceived dichorionic diamniotic (SC-DCDA), and assisted reproductive technology dichorionic diamniotic (ART-DCDA) twins.
Methods:
From 2016 to 2019, the ultrasonographic fetal biometric measurements were longitudinally collected in pregnant women, including fetal weight, biparietal diameter, head circumference, abdominal circumference, femur length, and humerus length. The linear mixed models were used to test the difference of growth patterns between groups, and the growth curve of each biometric parameter was modeled by a generalized additive model for location scale and shape.
Results:
A total of 929 twin pregnant women and 2019 singleton pregnant women, met the inclusion criteria. Among twin pregnancies, 148 were SC-MCDA, 215 were SC-DCDA, and 566 were ART-DCDA twins. Overall, SC-DCDA twins grew faster than SC-MCDA twins, while slower than ART-DCDA twins (all P < 0.05), and all of the three groups showed significant differences comparing with singletons, especially during the third trimester. Hence, the customized fetal growth charts of each fetal biometric parameter were, respectively, constructed for SC-MCDA, SC-DCDA, and ART-DCDA twins.
Conclusions:
The fetal biometric trajectories demonstrated characteristic patterns according to chorionicity and conception mode. To fill the gap, we modeled fetal biometric parameters for Chinese SC-MCDA, SC-DCDA, and ART-DCDA twin pregnancies, hoping to provide a reference for the further establishment of fetal growth reference values for Chinese twin fetuses.
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建立正常胎肺胎龄分级模型，探索深度学习算法在胎肺成熟度评估中的潜在价值Tai-Hui Xia, Man Tan, Jing-Hua Li, Jing-Jing Wang, Qing-Qing Wu, De-Xing Kong
中华医学杂志英文版2021年 134卷 15期
DOI: 10.1097/CM9.0000000000001547
摘要
Background:
Prenatal evaluation of fetal lung maturity (FLM) is a challenge, and an effective non-invasive method for prenatal assessment of FLM is needed. The study aimed to establish a normal fetal lung gestational age (GA) grading model based on deep learning (DL) algorithms, validate the effectiveness of the model, and explore the potential value of DL algorithms in assessing FLM.
Methods:
A total of 7013 ultrasound images obtained from 1023 normal pregnancies between 20 and 41 + 6 weeks were analyzed in this study. There were no pregnancy-related complications that affected fetal lung development, and all infants were born without neonatal respiratory diseases. The images were divided into three classes based on the gestational week: class I: 20 to 29 + 6 weeks, class II: 30 to 36 + 6 weeks, and class III: 37 to 41 + 6 weeks. There were 3323, 2142, and 1548 images in each class, respectively. First, we performed a pre-processing algorithm to remove irrelevant information from each image. Then, a convolutional neural network was designed to identify different categories of fetal lung ultrasound images. Finally, we used ten-fold cross-validation to validate the performance of our model. This new machine learning algorithm automatically extracted and classified lung ultrasound image information related to GA. This was used to establish a grading model. The performance of the grading model was assessed using accuracy, sensitivity, specificity, and receiver operating characteristic curves.
Results:
A normal fetal lung GA grading model was established and validated. The sensitivity of each class in the independent test set was 91.7%, 69.8%, and 86.4%, respectively. The specificity of each class in the independent test set was 76.8%, 90.0%, and 83.1%, respectively. The total accuracy was 83.8%. The area under the curve (AUC) of each class was 0.982, 0.907, and 0.960, respectively. The micro-average AUC was 0.957, and the macro-average AUC was 0.949.
Conclusions:
The normal fetal lung GA grading model could accurately identify ultrasound images of the fetal lung at different GAs, which can be used to identify cases of abnormal lung development due to gestational diseases and evaluate lung maturity after antenatal corticosteroid therapy. The results indicate that DL algorithms can be used as a non-invasive method to predict FLM.
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新疆农村人群人乳头瘤病毒分布与宫颈癌流行病学特征Yan Wang, Ying-Bin Cai, William James, Jian-Lin Zhou, Remila Rezhake, Qian Zhang
中华医学杂志英文版2021年 134卷 15期
DOI: 10.1097/CM9.0000000000001441
摘要
Background:
Cervical cancer remains a major public health issue for the Uyghur women and other women living mainly in rural areas of Xinjiang. This study aims to investigate the distribution of human papillomavirus (HPV) infection and cervical cancer in rural areas of Xinjiang, China.
Methods:
Cervical cancer screening was performed on rural women aged 35 to 64 years from Xinjiang, China in 2017 through gynecological examination, vaginal discharge smear microscopy, cytology, and HPV testing. If necessary, colposcopy and biopsy were performed on women with suspicious or abnormal screening results.
Results:
Of the 216,754 women screened, 15,518 received HPV testing. The HPV-positive rate was 6.75% (1047/15,518). Compared with the age 35-44 years group, the odds ratios (ORs) of HPV positivity in the age 45-54 years and 55-64 years groups were 1.18 (95% confidence interval [CI]: 1.02-1.37) and 1.84 (95% CI: 1.53-2.21), respectively. Compared with women with primary or lower education level, the ORs for HPV infection rates of women with high school and college education or above were 1.37 (95% CI: 1.09-1.72) and 1.62 (95% CI: 1.23-2.12), respectively. Uyghur women were less likely to have HPV infection than Han women, with an OR (95% CI) of 0.78 (0.61-0.99). The most prevalent HPV types among Xinjiang women were HPV 16 (24.00%), HPV 33 (12.70%), and HPV 52 (11.80%). The detection rate of cervical intraepithelial neoplasia (CIN)2+ was 0.14% and the early diagnosis rate of cervical cancer was 85.91%. The detection rates of vaginitis and cervicitis were 19.28% and 21.32%, respectively.
Conclusions:
The HPV infection rate in Xinjiang is low, but the detection rate of cervical cancer and precancerous lesions is higher than the national average level. Cervical cancer is a prominent public health problem in Xinjiang, especially in southern Xinjiang.
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海马慢性深部脑刺激诱导猕猴颞叶癫痫模型可逆性转录物改变Ning Chen, Jian-Guo Zhang, Chun-Lei Han, Fan-Gang Meng
中华医学杂志英文版2021年 134卷 15期
DOI: 10.1097/CM9.0000000000001644
摘要
Background:
Deep brain stimulation (DBS) has seizure-suppressing effects but the molecular mechanisms underlying its therapeutic action remain unclear. This study aimed to systematically elucidate the mechanisms underlying DBS-induced seizure suppression at a molecular level.
Methods:
We established a macaque model of mesial temporal lobe epilepsy (mTLE), and continuous high-frequency hippocampus DBS (hip-DBS) was applied for 3 months. The effects of hip-DBS on hippocampus gene expression were examined using high-throughput microarray analysis followed by bioinformatics analysis. Moreover, the microarray results were validated using quantitative real-time polymerase chain reaction (qRT-PCR) and Western blot analyses.
Results:
The results showed that chronic hip-DBS modulated the hippocampal gene expression. We identified 4119 differentially expressed genes and assigned these genes to 16 model profiles. Series test of cluster analysis showed that profiles 5, 3, and 2 were the predominant expression profiles. Moreover, profile 5 was mainly involved in focal adhesion and extracellular matrix-receptor interaction pathway. Nine dysregulated genes (Arhgap5, Col1a2, Itgb1, Pik3r1, Lama4, Fn1, Col3a1, Itga9, and Shc4) and three genes (Col1a2, Itgb1, and Flna) in these two pathways were further validated by qRT-PCR and Western blot analyses, respectively, which showed a concordance.
Conclusion:
Our findings suggest that hip-DBS could markedly reverse mTLE-induced abnormal gene expression. Findings from this study establish the basis for further investigation of the underlying regulatory mechanisms of DBS for mTLE.
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内毒素耐受条件下胸腺细胞群的变化Yi-Jing Tao, Juan-Juan Zhao, Li-Hua Rao, Song Yang, Guo-Liang Zhang, Meng-Meng Guo, Chao Chen, Lin Xu
中华医学杂志英文版2021年 134卷 15期
DOI: 10.1097/CM9.0000000000001598
摘要
Background:
Endotoxin tolerance (ET) is a protective phenomenon in which pre-treatment with a tolerance dose of lipopolysaccharide (LPS) leads to dramatically elevated survival. Accumulating evidence has shown that peripheral T cells contribute to the induction of ET. However, what happens to T cell development in the thymus under ET conditions remains unclear. The purpose of this study was to analyze the alterations in thymocyte populations (double-positive [DP] and single-positive [SP] cells) under ET conditions.
Methods:
Mice were intraperitoneally injected with LPS at a concentration of 5 mg/kg to establish an LPS tolerance model and were divided into two groups: a group examined 72 h after LPS injection (72-h group) and a group examined 8 days after LPS injection (8-day group). Injection of phosphate-buffered saline was used as a control (control group). Changes in thymus weight, cell counts, and morphology were detected in the three groups. Moreover, surface molecules such as CD4, CD8, CD44, CD69, and CD62L were analyzed using flow cytometry. Furthermore, proliferation, apoptosis, cytokine production, and extracellular signal-regulated kinase (ERK) pathway signaling were analyzed in thymocyte populations. The polymorphism and length of the T-cell receptor (TCR) β chain complementarity-determining region 3 (CDR3) were analyzed using capillary electrophoresis DNA laser scanning analysis (ABI 3730).
Results:
Thymus weight and cell counts were decreased in the early stage but recovered by the late stage in a murine model of LPS-induced ET. Moreover, the proportions of DP cells (control: 72.130 ± 4.074, 72-h: 10.600 ± 3.517, 8-day: 84.770 ± 2.228), CD4+ SP cells (control: 15.770 ± 4.419, 72-h: 44.670 ± 3.089, 8-day: 6.367 ± 0.513), and CD8+ SP cells (control: 7.000 ± 1.916, 72-h: 34.030 ± 3.850, 8-day: 5.133 ± 0.647) were obviously different at different stages of ET. The polymorphism and length of TCR β chain CDR3 also changed obviously, indicating the occurrence of TCR rearrangement and thymocyte diversification. Further analysis showed that the expression of surface molecules, including CD44, CD69, and CD62L, on thymocyte populations (DP and SP cells) were changed to different degrees. Finally, the proliferation, apoptosis, cytokine production, and ERK pathway signaling of thymocyte populations were changed significantly.
Conclusion:
These data reveal that alterations in thymocyte populations might contribute to the establishment of ET.
Clinical Observation
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肿瘤大小对色素性基底细胞癌皮肤镜特征的影响Li-Juan Xu, Ling-Ling Zheng, Wei Zhu
中华医学杂志英文版2021年 134卷 15期
DOI: 10.1097/CM9.0000000000001571
摘要
基底细胞癌（BCC）是最常见的皮肤恶性肿瘤，在世界范围内发病率逐年上升。大多数基底细胞癌是一种惰性肿瘤，它可以生长成一个大的病灶并失去其经典表现。此外，巨型BCC近年来也引起了研究者的关注。[
Correspondence
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一个与家族性低钙高钙血症明显常染色体隐性遗传相关的钙敏感受体基因纯合突变Nan Li, Xiang Li, Xiao-Lin Ni, Xiu-Ying Li, Wei-Bo Xia, Guo-Qing Yang, Yu Pei
中华医学杂志英文版2021年 134卷 15期
DOI: 10.1097/CM9.0000000000001568
摘要
致编辑：家族性低钙性高钙血症（FHH）包括一组罕见的钙稳态遗传性疾病，其特征是终身高钙血症，通常无症状，尿钙排泄不当低。FHH是遗传异质性的。大多数病例是FHH1，由于钙敏感受体的失活突变（CASR）3号染色体上的基因。FHH2和FHH3分别是由于G蛋白亚基α 11基因和衔接子相关蛋白复合物2亚基σ 1基因中的失活突变。
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超声引导下同轴穿刺活检诊断儿童嗜酸性膀胱炎Yan-Bing Luo, Qiang Gao, Jing Guo, Yong Zhang, Jian Sun, Wei-Yu Li, Er-Long Xiao
中华医学杂志英文版2021年 134卷 15期
DOI: 10.1097/CM9.0000000000001564
摘要
致编辑：嗜酸性膀胱炎（EC）是一种罕见的疾病，其特征是膀胱壁的透壁嗜酸性炎症，伴有尿频增加、血尿、排尿困难和耻骨上疼痛。[
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持续的AMP激活蛋白激酶激活减弱慢性应激小鼠脑源性神经营养因子/酪氨酸激酶受体B信号的活性Li-Tao Yi, Shuang-Shuang Wang, Jie Cheng, Min Chen, Ji-Xiao Zhu, Cheng-Fu Li, Shu-Qi Dong, Qing Liu
中华医学杂志英文版2021年 134卷 15期
DOI: 10.1097/CM9.0000000000001323
摘要
致编辑：重度抑郁症是世界范围内导致残疾的最主要原因之一。抑郁症的分子病理生理学是复杂的，已经引起了广泛的关注。[
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胸痛型变异型哮喘2例报告Ling Shen
中华医学杂志英文版2021年 134卷 15期
DOI: 10.1097/CM9.0000000000001495
摘要
致编辑：非典型哮喘，如胸痛型变异性哮喘（CPVA），常导致误诊。非典型哮喘患者通常不表现为喘息和呼吸困难，并且经常被误诊为冠状动脉疾病（CAD）、胃食管反流病（GERD）和其他疾病。诊断哮喘的金标准是肺功能测试（PFT），尽管有时也使用治疗性测试。在以前的研究中已经报道了几例CPVA病例；[
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一例成人纤维化纵隔炎患者通过拉开尺寸过小的支架挽救肺动脉支架内再狭窄Yi-Chao Duan, Hong-Ling Su, Yan Zhu, Xin Pan, Kai-Yu Jiang, A-Qian Wang, Guan-Ming Qi, Yan Zhang, Yun-Shan Cao
中华医学杂志英文版2021年 134卷 15期
DOI: 10.1097/CM9.0000000000001493
摘要
致编辑：71岁男性，因进行性劳力性呼吸困难入院。他有纤维化纵隔炎（FM）诱导的肺血管狭窄病史。他的右肺叶间动脉严重狭窄，植入了一个直径为6毫米的支架（6毫米× 18毫米；PALMAZ®蓝色TM，Cordis，上海，中国）入院前6个月，其左上肺静脉已植入9 mm直径支架（9 mm × 29 mm；ExpressTM血管LD，波士顿科学公司，马尔伯勒，马萨诸塞州，美国）入院前1个月。
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鼻炎可能是原发性肺淋巴上皮瘤样癌的临床症状，这是新冠肺炎疫情期间的一个偶然发现Ke Huang, Yu Zhu, Jian Zhu, Bin Huang, Xu-Hui Gao
中华医学杂志英文版2021年 134卷 15期
DOI: 10.1097/CM9.0000000000001541
摘要
致编辑：原发性肺淋巴上皮瘤样癌（PPLELC）被认为是一种罕见的肺癌类型，由长期EB病毒感染引起，临床症状与大多数肺癌相似。在新冠肺炎疫情期间，我们治疗了一名看似无症状的PPLELC合并症患者，该患者因慢性鼻炎急性发作入院。胸部计算机断层扫描（CT）显示患者肺部有异常肿块。基于这个临床病例，我们提出慢性EB病毒相关性鼻炎和PPLELC之间存在正相关。此外，我们建议感染EB病毒的鼻炎患者接受持续的抗病毒治疗，并定期监测病毒浓度和CT扫描。
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基于肿瘤微环境的药物发现：膀胱癌免疫治疗的新视角Xiao-Nan Zheng, Shi Qiu, Lian-Sha Tang, Jian-Zhong Ai, Xin-Yang Liao, Kun Jin, Xiang-Hong Zhou, Di Jin, Lu Yang, Bai-Rong Shen 等
中华医学杂志英文版2021年 134卷 15期
DOI: 10.1097/CM9.0000000000001535
摘要
致编辑：膀胱癌（BCa）是最常见的泌尿系恶性肿瘤之一。2020年全球发病率为573,278例，在所有肿瘤中排名第十一位。[
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痤疮与吸烟的关系：观察性研究的系统综述和荟萃分析Jing-Zhan Zhang, Fang Xiang, Shi-Rong Yu, Dong Luo, Ting-Ting Li, Xiao-Jing Kang
中华医学杂志英文版2021年 134卷 15期
DOI: 10.1097/CM9.0000000000001286
摘要
致编辑：痤疮是一种慢性炎症性疾病，常见于皮脂腺丰富的地区。它更有可能产生永久性的萎缩性或肥大性疤痕，从而导致严重的心理社会后果并降低患者的生活质量。[
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铁输注和较新的静脉铁制剂Tim Aung, Sandy T. Aung
中华医学杂志英文版2021年 134卷 15期
DOI: 10.1097/CM9.0000000000001525
摘要
致编辑：缺铁（ID）和ID贫血（IDA）是世界范围内常见的健康问题。世界卫生组织（2011年）估计，34%的全球人口（>20亿）受到贫血的影响，最常见的类型是ID（占总贫血的50%），主要影响育龄妇女。[
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