MedNexus
2022年 · 第135卷第03期
出版日期 2022-02-05电子版 ￥0.00元
MedNexus
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Review Article
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糖尿病视网膜病变的人工智能Sicong Li, Ruiwei Zhao, Haidong Zou
中华医学杂志英文版2022年 135卷 03期
DOI: 10.1097/CM9.0000000000001816
摘要
Diabetic retinopathy (DR) is an important cause of blindness globally, and its prevalence is increasing. Early detection and intervention can help change the outcomes of the disease. The rapid development of artificial intelligence (AI) in recent years has led to new possibilities for the screening and diagnosis of DR. An AI-based diagnostic system for the detection of DR has significant advantages, such as high efficiency, high accuracy, and lower demand for human resources. At the same time, there are shortcomings, such as the lack of standards for development and evaluation and the limited scope of application. This article demonstrates the current applications of AI in the field of DR, existing problems, and possible future development directions.
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HER2阳性乳腺癌中的抗体-药物偶联物Lixi Li, Di Zhang, Binliang Liu, Dan Lv, Jingtong Zhai, Xiuwen Guan, Zongbi Yi, Fei Ma
中华医学杂志英文版2022年 135卷 03期
DOI: 10.1097/CM9.0000000000001932
摘要
Antibody-drug conjugates (ADCs) combine the high specificity of monoclonal antibodies with the high anti-tumor activity of small molecular cytotoxic payloads. The anti-tumor activity of ADCs is mainly achieved by the direct blocking of the receptor by monoclonal antibodies, direct action and bystander effect of cytotoxic drugs, and antibody-dependent cell-mediated cytotoxicity and complement-dependent cytotoxicity. ADCs have been used in adjuvant therapy and rescue treatment of human epidermal receptor 2 (HER2)-positive breast cancer, greatly improving the prognosis of breast cancer patients. Several ongoing clinical trials of ADC for breast cancer and other solid tumors proved the potential of ADCs will provide more promising treatment options for patients with malignant tumors. This review introduces the mechanism and latest clinical progress of ADC drugs approved for HER2-positive breast cancer to guide clinical practice and conduct research.
Meta Analysis
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染色体微阵列分析vs.胎儿脑室扩大的核型分析Yan Sun, Weiyuan Zhang, Zhiwen Wang, Likui Guo, Shaowen Shi
中华医学杂志英文版2022年 135卷 03期
DOI: 10.1097/CM9.0000000000001683
摘要
Background:
Chromosomal abnormalities are important causes of ventriculomegaly (VM). In mild and isolated cases of fetal VM, obstetricians rarely give clear indications for pregnancy termination. We aimed to calculate the incidence of chromosomal abnormalities and incremental yield of chromosomal microarray analysis (CMA) in VM, providing more information on genetic counseling and prognostic evaluation for fetuses with VM.
Methods:
The Chinese language databases Wanfang Data, China National Knowledge Infrastructure, and China Biomedical Literature Database (from January 1, 1991 to April 29, 2020) and English language databases PubMed, Embase, and Cochrane Library (from January 1, 1945 to April 29, 2020) were systematically searched for articles on fetal VM. Diagnostic criteria were based on ultrasonographic or magnetic resonance imaging (MRI) assessment of lateral ventricular atrium width: ≥10 to <15 mm for mild VM, and ≥15 mm for severe VM. Isolated VM was defined by the absence of structural abnormalities other than VM detected by ultrasonography or MRI. R software was used for the meta-analysis to determine the incidence of chromosomal abnormalities and incremental yield of CMA in VM, and the combined rate and 95% confidence interval (CI) were calculated.
Results:
Twenty-three articles involving 1635 patients were included. The incidence of chromosomal abnormalities in VM was 9% (95% CI: 5%-12%) and incremental yield of CMA in VM was 11% (95% CI: 7%-16%). The incidences of chromosomal abnormalities in mild, severe, isolated, and non-isolated VM were 9% (95% CI: 4%-16%), 5% (95% CI: 1%-11%), 3% (95% CI: 1%-6%), and 13% (95% CI: 4%-25%), respectively.
Conclusions:
Applying CMA in VM improved the detection rate of abnormalities. When VM is confirmed by ultrasound or MRI, obstetricians should recommend fetal karyotype analysis to exclude chromosomal abnormalities. Moreover, CMA should be recommended preferentially in pregnant women with fetal VM who are undergoing invasive prenatal diagnosis. CMA cannot completely replace chromosome karyotype analysis.
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孕妇或婴儿补充维生素D预防过敏性疾病：随机对照试验的系统综述和荟萃分析Chao Luo, Yaning Sun, Zuojing Zeng, Ying Liu, Shunlin Peng
中华医学杂志英文版2022年 135卷 03期
DOI: 10.1097/CM9.0000000000001951
摘要
Background:
It is still unclear if and to what extent antenatal or infant or childhood vitamin D supplementation would affect the development of allergy diseases later in life. This study aimed to review the efficacy of vitamin D supplementation in pregnant women, infants, or children for the prevention of allergies.
Methods:
MEDLINE (PubMed), EMBASE (OVID), and the Cochrane Central Register of Controlled Trials were searched up to March 1, 2020. We included only randomized controlled trials (RCTs). We performed a systematic review and meta-analysis for vitamin D supplementation in primary allergy prevention. These trials were assessed for risk of bias using the Cochrane Collaboration domains and the consensus was reached via discussion with the full study group. We descriptively summarized and quantitatively synthesized original data to evaluate vitamin D supplementation in primary allergy prevention by using Review Manager software for meta-analysis.
Results:
The search yielded 1251 studies. Seven RCTs were included in this analysis. A meta-analysis revealed that vitamin D supplementation for pregnant women or infants may not decrease the risk of developing allergic diseases, such as asthma or wheezing (supplementation for pregnant women, risk ratio [RR]: 1.01, 95% confidence interval [CI]: 0.81-1.26, P = 0.90, I2 = 47%; supplementation for infants, RR: 1.00, 95% CI: 0.70-1.43, P = 0.99, I2 = 0%; supplementation for pregnant women and infants, RR: 0.35, 95% CI: 0.10-1.25, P= 0.11), eczema (supplementation for pregnant women, RR: 0.95, 95% CI: 0.80-1.13, P= 0.77, I2= 0%; supplementation for infants, RR: 0.84, 95% CI: 0.64-1.11, P= 0.19, I2= 42%), allergic rhinitis (supplementation for pregnant women, RR: 0.93, 95% CI: 0.78-1.11, P = 0.15, I2 = 47%), lower respiratory tract infection (LRTI) (supplementation for pregnant women, RR: 0.97, 95% CI: 0.85-1.11, P = 0.59, I2 = 0%), or food allergy.
Conclusions:
Supplementation of vitamin D in pregnant women or infants does not have an effect on the primary prevention of allergic diseases.
Systematic Review Registration:
PROSPERO (CRD42020167747)
Viewpoint
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从“台阶式”到“台阶式”：感染性坏死性胰腺炎的跨越式干预Dongya Huang, Qiang Li, Zipeng Lu, Kuirong Jiang, Junli Wu, Wentao Gao, Bin Xiao, Yi Miao
中华医学杂志英文版2022年 135卷 03期
DOI: 10.1097/CM9.0000000000001877
摘要
急性胰腺炎（AP）的严重程度差异很大，从临床上的自限性到迅速致命的病程。[
Original Article
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2型糖尿病患者范围时间与癌症死亡率的关系：一项前瞻性队列研究Yun Shen, Chunfang Wang, Yaxin Wang, Jingyi Lu, Lei Chen, Lei Zhang, Wei Lu, Wei Zhu, Gang Hu, Tian Xia 等
中华医学杂志英文版2022年 135卷 03期
DOI: 10.1097/CM9.0000000000001740
摘要
Background:
Little was known about the association among time in range (TIR), time above range (TAR), time below range (TBR), and cancer mortality among patients with type 2 diabetes. We aimed to investigate the association among TIR, TAR, TBR, and the risk of cancer mortality among patients with type 2 diabetes.
Methods:
A total of 6225 patients with type 2 diabetes were prospectively recruited in Shanghai, China. TIR was measured with continuous glucose monitoring at baseline and was defined as the average percentage of time in the target glucose range during a 24 h period. Cox proportion hazard regression analysis was used to determine the association between TIR and the risk of cancer mortality.
Results:
During a mean follow-up of 7.10 years, we confirmed 237 death events related to cancer. The multivariable-adjusted hazard ratio (HR) for cancer mortality was 1.32 (95% confidence interval [CI]: 1.01-1.75) in patients with TIR ≤70% compared with those with TIR >70%. When TIR was considered as a continuous variable, the multivariable-adjusted HR for cancer mortality associated with each 10% decrease in TIR was 1.07 (95% CI: 1.02-1.14). In the site-specific analysis, a significant association between TIR as a continuous variable and the risk of hepatocellular cancer was found (HR: 1.24; 95% CI: 1.09-1.41). However, no relationship between hemoglobin A1c and cancer mortality was observed (HR: 1.04; 95% CI: 0.97-1.10).
Conclusions:
The present study found an inverse association of TIR with the risk of cancer mortality among patients with type 2 diabetes. New evidence of TIR was added into the clinical practice that TIR may be an optimal target of glycemic control among patients with type 2 diabetes.
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中国糖尿病患者心血管风险特征和临床特征的横断面研究Fang Lyu, Xiaoling Cai, Chu Lin, Tianpei Hong, Xiaomei Zhang, Juming Lu, Xiaohui Guo, Zhufeng Wang, Huifang Xing, Guizhi Zong 等
中华医学杂志英文版2022年 135卷 03期
DOI: 10.1097/CM9.0000000000001741
摘要
Background:
Cardiovascular (CV) disease is the leading cause of morbidity and mortality in adults with type 2 diabetes (T2D). The aim of this study was to determine the CV risk in Chinese patients with T2D based on the 2019 European Society of Cardiology (ESC) and the European Association for the Study of Diabetes (EASD) guidelines on diabetes, pre-diabetes, and CV diseases.
Methods:
A total of 25,411 patients with T2D, who participated in the study of China Cardiometabolic Registries 3B study, were included in our analysis. We assessed the proportions of patients in each CV risk category according to 2019 ESC/EASD guidelines.
Results:
Based on the 2019 ESC/EASD guidelines, 16,663 (65.6%), 1895 (7.5%), and 152 (0.6%) of patients were included in "very high risk," "high risk," and "moderate risk" categories, respectively. The proportions of patients in each category varied based on age, sex, body mass index, and duration. While 58.7% (9786/16,663) of elderly patients were classified to "very high risk" group, 89.6% (3732/4165) of patients with obesity were divided into "very high risk" group. Almost all patients with a duration of diabetes >10 years had "very high risk" or "high risk." However, 6701 (26.4%) of Chinese T2D patients, who had shorter duration, and one or two risk factors, could not be included in any category (the "unclear risk" category).
Conclusions:
In China, most patients with T2D have "very high" or "high" CV risk based on 2019 ESC/EASD guidelines. However, the risk of patients in "unclear risk" group needs to be further classified.
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替诺福韦vs恩替卡韦对肝切除术后超过米兰标准的乙型肝炎病毒相关性肝细胞癌复发的影响Junyi Shen, Weili Qi, Junlong Dai, Shusheng Leng, Kangyi Jiang, Yu Zhang, Shun Ran, Chuan Li, Tianfu Wen
中华医学杂志英文版2022年 135卷 03期
DOI: 10.1097/CM9.0000000000001864
摘要
Background:
Hepatectomy for hepatocellular carcinoma (HCC) beyond the Milan criteria is shown to be beneficial. However, a high rate of post-operative HCC recurrence hinders the long-term survival of the patients. This study aimed to investigate and compare the impacts of tenofovir (TDF) and entecavir (ETV) on the recurrence of hepatitis B viral (HBV)-related HCC beyond the Milan criteria.
Methods:
Data pertaining to 1532 patients who underwent hepatectomy and received antiviral therapy between January 2014 and January 2019 were collected from five centers. Recurrence-free survival (RFS) analysis was performed using the Kaplan-Meier method. Cox proportional hazards regression analysis was performed to determine prognostic factors for HCC recurrence.
Results:
The analysis incorporates 595 HBV-related HCC patients. The overall 5-year RFS was 21.3%. Among them, 533 and 62 patients received ETV and TDF treatment, respectively. The 1-, 3-, and 5-year RFS rates were 46.3%, 27.4%, and 19.6%, respectively, in the ETV group compared with 65.1%, 41.8%, and 37.2%, respectively, in the TDF group (P < 0.001). Multivariate analysis showed that TDF treatment (hazard ratio [HR]: 0.604, P = 0.005), cirrhosis (HR: 1.557, P = 0.004), tumor size (HR: 1.037, P = 0.008), microvascular invasion (MVI) (HR: 1.403, P = 0.002), portal vein tumor thrombus (PVTT) (HR: 1.358, P = 0.012), capsular invasion (HR: 1.228, P= 0.040), and creatinine levels (CREA) (HR: 0.993, P = 0.031) were statistically significant prognostic factors associated with RFS.
Conclusions:
Patients with HCC beyond the Milan criteria exhibited a high rate of HCC recurrence after hepatectomy. Compared to the ETV therapy, TDF administration significantly lowered the risk of HCC recurrence.
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胃肿瘤内镜黏膜下剥离术术中大出血及术后出血的危险因素分析Shanshan Xu, Ningli Chai, Xiaowei Tang, Enqiang Linghu, Shasha Wang
中华医学杂志英文版2022年 135卷 03期
DOI: 10.1097/CM9.0000000000001840
摘要
Background:
Endoscopic resection bleeding (ERB) classification was proposed by the authors’ team to evaluate the severity of intraoperative bleeding (IB) during endoscopic submucosal dissection (ESD). This study aimed to evaluate the application of ERB classification and to analyze the risk factors of major IB (MIB) and postoperative bleeding (PB) associated with ESD for gastric neoplastic lesions.
Methods:
We retrospectively enrolled a total of 1334 patients who underwent ESD between November 2006 and September 2019 at The First Medical Center of Chinese People’s Liberation Army General Hospital. All patients were divided into the non-MIB group (including ERB-0, ERB-controlled 1 [ERB-c1], and ERB-c2) and the MIB group (including ERB-c3 and ERB-uncontrolled [ERB-unc]) according to the ERB classification. Risk factors of major MIB and risk factors of PB were analyzed using a logistic regression model.
Results:
Among the 1334 patients, 773 (57.95%) had ERB-0, 477 (35.76%) had ERB-c1, 77 (5.77%) had ERB-c2, 7 (0.52%) had ERB-c3, and no patients had ERB-unc. The rate of PB in patients with IB classifications of ERB-0, ERB-c1, ERB-c2, and ERB-c3 were 2.20% (17/773), 3.35% (16/477), 9.09% (7/77), and 2/7, respectively. In multivariate analysis, proximal location (odds ratio [OR]: 1.488; 95% confidence interval [CI]: 1.045-3.645; P = 0.047) was the only significant risk factor of MIB. Chronic kidney disease (CKD) (OR: 7.844; 95% CI: 1.637-37.583; P = 0.010) and MIB (ERB-c3) (OR: 13.932; 95% CI: 2.585-74.794; P = 0.002) were independent risk factors of PB.
Conclusions:
Proximal location of lesions was a significant risk factor of MIB. Additionally, CKD and MIB (ERB-c3) were independent risk factors of PB. More attention should be paid to these high-risk patients for MIB and PB.
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使用负荷剂量可更早达到万古霉素的目标血清浓度Yanxia Huang, Le He, Yunxin Deng, Renjing Zhang, Mei Meng, Jiao Liu, Dechang Chen
中华医学杂志英文版2022年 135卷 03期
DOI: 10.1097/CM9.0000000000001905
摘要
Background:
Vancomycin treatment failure against vancomycin-susceptible gram-positive cocci is not rare in the intensive care unit (ICU). One of the reasons for this is the substandard drug trough concentration. We aimed to examine the hypothesis that the target serum concentration could be reached earlier with a loading dose of vancomycin.
Methods:
This retrospective cohort study was conducted at our ICU between June 2018 and June 2020 and involved patients who were suspected of having, or confirmed to have, gram-positive cocci infection and treated with vancomycin. One group of the patients was administered a loading dose of vancomycin (loading group) and compared with the group that did not receive a loading dose (control group). The baseline characteristics, vancomycin serum concentrations, and clinical outcomes were collected and analyzed.
Results:
Fifty-five patients were finally included, of which 29 received a loading dose of vancomycin. The serum concentration of vancomycin before the second dose was significantly higher for the loading group than for the control group (10.3 ± 6.1 mg/L vs. 5.7 ± 4.4 mg/L, P = 0.002). The results for both groups were similar before the fifth dose (12.4 ± 7.3 mg/L vs. 10.3 ± 6.3 mg/L in the loading and the control groups, respectively; P = 0.251). The 28-day mortality was lower for the loading group than for the control group (6.7% vs. 34.6% in the loading and control groups, respectively; P = 0.026). No significant differences were observed in serum creatinine (Cr) concentrations of the two groups.
Conclusion:
With the loading dose of vancomycin, the target serum concentration of vancomycin may be reached earlier without increasing the risk of acute kidney injury.
Trial registration:
https://www.chictr.org.cn; ChiCTR2000035369
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自噬，而不是凋亡，在小汗腺类器官的管腔形成中起作用Lijie Du, Lei Zhang, Junhong Zhao, Zixiu Chen, Xiang Liu, Manxiu Cao, Lei You, Yonghong Zhang, Xiaobing Fu, Haihong Li
中华医学杂志英文版2022年 135卷 03期
DOI: 10.1097/CM9.0000000000001936
摘要
Background:
Sweat secreted by eccrine sweat glands is transported to the skin surface through the lumen. The eccrine sweat gland develops from the initial solid bud to the final gland structure with a lumen, but how the lumen is formed and the mechanism of lumen formation have not yet been fully elucidated. This study aimed to investigate the mechanism of lumen formation of eccrine gland organoids (EGOs).
Methods:
Human eccrine sweat glands were isolated from the skin for tissue culture, and the primary cultured cells were collected and cultured in Matrigel for 14 days in vitro. EGOs at different development days were collected for hematoxylin and eosin (H&E) staining to observe morphological changes and for immunofluorescence staining of proliferation marker Ki67, cellular motility marker filamentous actin (F-actin), and autophagy marker LC3B. Western blotting was used to detect the expression of Ki67, F-actin, and LC3B. Moreover, apoptosis was detected using a terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) apoptosis assay kit, and the expression of poly (ADP-ribose) polymerase and Caspase-3 was detected by Western blot. In addition, 3-methyladenine (3MA) was used as an autophagy inhibitor to detect whether the formation of sweat glands can be effectively inhibited.
Results:
The results showed that a single gland cell proliferated rapidly and formed EGOs on day 4. The earliest lumen formation was observed on day 6. From day 8 to day 14, the rate of lumen formation in EGOs increased significantly. The immunofluorescence and Western blot analyses showed that the expression of Ki67 gradually decreased with the increase in days, while the F-actin expression level did not change. Notably, the expression of autophagy marker LC3B was detected in the interior cells of EGOs as the apoptosis signal of EGOs was negative. Compared with the control group, the autophagy inhibitor 3MA can effectively limit the formation rate of the lumen and reduce the inner diameter of EGOs.
Conclusion:
Using our model of eccrine gland 3D-reconstruction in Matrigel, we determined that autophagy rather than apoptosis plays a role in the lumen formation of EGOs.
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诺模图预测淋巴结阳性乳腺癌患者新辅助化疗后腋窝淋巴结病理反应Wenyan Wang, Xin Wang, Jiaqi Liu, Qiang Zhu, Xiang Wang, Pilin Wang
中华医学杂志英文版2022年 135卷 03期
DOI: 10.1097/CM9.0000000000001876
摘要
Background:
Pathological complete response (pCR) of axillary lymph nodes (ALNs) is frequently achieved in patients with clinically node-positive breast cancer after neoadjuvant chemotherapy (NAC), and ALN status is an important prognostic factor for breast cancer patients. This study aims to develop a new predictive clinical model to assess the ALN pCR rate after NAC.
Methods:
This was a retrospective series of 467 patients who had biopsy-proven positive ALNs at diagnosis and underwent ALN dissection from 2007 to 2014 at the National Cancer Center/Cancer Hospital of the Chinese Academy of Medical Sciences. We analyzed the clinicopathologic features of the patients and developed a nomogram to predict the probability of ALN pCR. A multivariable logistic regression stepwise model was used to construct a nomogram to predict ALN pCR in node-positive patients. The adjusted area under the receiver operating characteristic curve (AUC) was calculated to quantify the ability to rank patients by risk. Internal validation was performed using the 50/50 hold-out validation method. The nomogram was externally validated with prospective cohorts of 167 patients from 2016 to 2018 at the Cancer Hospital of the Chinese Academy of Medical Sciences and 114 patients from 2018 to 2020 at Beijing Tiantan Hospital.
Results:
In this retrospective study, 115 (24.6%) patients achieved ALN pCR after NAC. Multivariate analysis showed that clinical tumor stage (Odds ratio [OR]: 0.321, 95% confidence interval [CI]: 0.121-0.856; P = 0.023); primary tumor response (OR: 0.189; 95% CI: 0.123-0.292; P < 0.001), and estrogen receptor status (OR: 0.530, 95% CI: 0.304-0.925; P = 0.025) were independent predictors of ALN pCR. The nomogram was constructed based on the result of multivariate analysis. In the internal validation of performance of nomogram, the AUCs for the training and test sets were 0.719 and 0.753, respectively. The nomogram was validated in external cohorts with AUCs of 0.720, which demonstrated good discriminatory power in these data sets.
Conclusion:
We developed a nomogram to predict the likelihood of axillary pCR in node-positive breast cancer patients after NAC. The predictive model performed well in multicenter prospective external validation. This practical tool could provide information to surgeons regarding whether to perform additional ALN dissection after NAC.
Trial registration:
ChiCTR.org.cn, ChiCTR1800014968.
Clinical Observation
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原发性心脏恶性肿瘤的临床特点及预后因素Jiaojiao Qiu, Yun Sun, Shuxia Wang, Jing Dong, Ping Zhu
中华医学杂志英文版2022年 135卷 03期
DOI: 10.1097/CM9.0000000000001623
摘要
原发性恶性心脏肿瘤（PMCTs）罕见但高度致死，其中高达75%是肉瘤，其次是淋巴瘤和间皮瘤。[
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早期血流动力学、氧代谢和乳酸动力学对心脏骤停后综合征预后的影响Mingqing Zhang, Qian Zhang, Yanan Yu, Le An, Zhijiang Qi, Chunsheng Li
中华医学杂志英文版2022年 135卷 03期
DOI: 10.1097/CM9.0000000000001807
摘要
心脏骤停(CA)的年发病率为0.5至1.5/1000，已成为主要的全球公共卫生问题。[
Correspondence
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非线性光学显微镜对隆突性皮肤纤维肉瘤与皮肤纤维瘤的鉴别诊断Wei Tian, Xiaoqin Zhu, Xiaomin Huang, Ying Huang, Yamin Lin, Yinghong Yang, Jianxin Chen, Lihang Lin
中华医学杂志英文版2022年 135卷 03期
DOI: 10.1097/CM9.0000000000001548
摘要
致编辑：隆突性皮肤纤维肉瘤（DFSP）是一种局部侵袭性皮肤间充质肿瘤，由于相似的组织学特征，可能被误诊为皮肤纤维瘤（DF）。[
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中国西部甲状腺功能正常人群甲状腺激素与代谢综合征的关系：一项基于流行病学和遗传学分析的横断面研究Shengru Liang, Jing Cai, Yang Yang, Lei Zhang, Peter Taylor, Jie Ming, Xinwen Yu, Ruofan Hu, Jie Zhou, Colin M. Da-Yan 等
中华医学杂志英文版2022年 135卷 03期
DOI: 10.1097/CM9.0000000000001553
摘要
致编辑：代谢综合征（MetS）被定义为一组代谢紊乱，包括腹型肥胖、高血糖、高血压和血脂异常。[
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超声扫描的检测灵敏度vs胰岛素注射相关脂肪肥大的临床检查Jian Yu, Hong Wang, Min Zhu, Dan Yan, Boqiang Fan, Yun Shi, Min Shen, Xiaoyun Liu, Wei He, Dan Luo 等
中华医学杂志英文版2022年 135卷 03期
DOI: 10.1097/CM9.0000000000001742
摘要
致编辑：脂肪肥大（LH）是由多次重叠胰岛素注射引起的最常见的局部并发症。临床上，LH表现为注射或输注部位组织突出和/或增厚，有时导致皮下肿块形成。在组织学上，LH的特征在于胰岛素注射部位皮下组织中血管分布减少、纤维化和脂肪细胞增大和增殖。正因为如此，现有的LH筛查方法主要以临床检查和超声扫描（USS）为主。最近的一项系统综述显示，迄今为止，在用于鉴定LH的不同方法中，只有有限的信息可用于检测灵敏度。到目前为止，黄体生成素诊断的金标准检查仍有争议，对于哪些患者需要这两种检查还没有足够的研究。目前，USS的探测灵敏度vsLH的临床检查尚未在基于大样本的研究中报道。本研究旨在使用大型患者队列比较USS和临床检查之间的检测准确性，并确定两种方法之间LH检测结果不一致的影响因素。
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中国成年2型糖尿病患者的血脂控制：时间趋势和地理区域差异的回顾性分析Yanping Yuan, Xianghai Zhou, Juming Lu, Xiaohui Guo, Linong Ji
中华医学杂志英文版2022年 135卷 03期
DOI: 10.1097/CM9.0000000000001895
摘要
致编辑：相对于没有糖尿病的人，二型糖尿病患者患心血管疾病（CVD）的风险更高。糖尿病患者总是表现出脂质异常。经济的快速发展和城市化进程的加快也导致了生活方式的改变，这可能会对中国糖尿病患者的血脂参数产生影响。鉴于中国社会经济地位的显著差异，在中国普通人群中≥45岁个体中血脂异常的患病率、知晓率、治疗和控制也观察到地理差异。[
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肱骨近端髓质特征年龄相关变化的形态学研究Wei Zhang, Zuhao Chang, Jiantao Li, Peifu Tang, Hua Chen
中华医学杂志英文版2022年 135卷 03期
DOI: 10.1097/CM9.0000000000001597
摘要
致编辑：肱骨近端骨折（PHF）主要发生在60岁以上患有严重骨质疏松症的患者中。[
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男孩整个青春期的激素变化：先天性低促性腺激素性性腺功能减退症治疗结果的观察性研究Xiaoya Ren, Yuanyuan Tian, Guoshuang Feng, Yi Wang, Beibei Zhang, Bingyan Cao, Jiajia Chen, Chunxiu Gong
中华医学杂志英文版2022年 135卷 03期
DOI: 10.1097/CM9.0000000000001639
摘要
致编辑：很难捕捉正常儿童青春期开始的确切时间，例如女孩的乳房和男孩的睾丸开始生长的时间，尤其是男孩。因此，对青春期身体发育的详细模式以及青春期开始和发育成熟时激素的临界值和变化的研究很少。通常认为，青春期期间的激素变化是黄体生成素（LH）对青春期开始的刺激作用的直接结果；[
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应用生物信息学方法鉴定特发性肺纤维化自噬相关基因Shulei Sun, Lixia Dong, Shuo Li, Jie Cao
中华医学杂志英文版2022年 135卷 03期
DOI: 10.1097/CM9.0000000000001633
摘要
致编辑：特发性肺纤维化(IPF)是一种慢性、进行性和纤维化性肺部疾病。IPF的临床过程包括呼吸困难、肺功能下降和咳嗽。IPF患者的中位生存期约为3年。5年生存率不到30%。[
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吡非尼酮在2019年重症冠状病毒疾病住院成人患者中的试验Fengqin Zhang, Yanqiu Wei, Li He, Huilan Zhang, Qiongjie Hu, Huihui Yue, Jianhan He, Huaping Dai
中华医学杂志英文版2022年 135卷 03期
DOI: 10.1097/CM9.0000000000001614
摘要
致编辑：2019年爆发的2019冠状病毒病（COVID-19）已成为全球大流行。与2003年的严重急性呼吸综合征冠状病毒（SARS-CoV）类似，新型冠状病毒可导致急性肺损伤和细胞因子风暴，其特征是白细胞介素（IL）-8、IL-6和肿瘤坏死因子α（TNF-α）升高。[
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乙型肝炎病毒相关性混合冷球蛋白血症的临床生物学特征及治疗Xiufen Wang, Xiangcheng Xiao, Huipeng Ge, Tianci Deng, Qiaoling Zhou, Jianping Ning, Xiaoying Wu, Hongling Yin, Wei Lin, Wenbin Tang
中华医学杂志英文版2022年 135卷 03期
DOI: 10.1097/CM9.0000000000001714
摘要
致编辑：冷球蛋白血症是一种以血清中冷球蛋白在体外条件<37℃，复温时再溶解。分为三种类型：I型，其中冷球蛋白由单克隆IgG或IgM组成，很少由IgA或游离免疫球蛋白（Ig）轻链组成；II型，其中冷球蛋白由具有类风湿因子(RF)活性的单克隆IgM和多克隆IgG制成；和III型，其中冷球蛋白由具有RF活性的多克隆IgM和多克隆IgG组成。[
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先天性脊柱侧凸的计划外手术Huiliang Yang, Gihye Im, Ce Zhu, Camilo Osorio, Umar Masood, Chunguang Zhou, Xi Yang, Limin Liu, Yueming Song
中华医学杂志英文版2022年 135卷 03期
DOI: 10.1097/CM9.0000000000001786
摘要
致编辑：先天性脊柱侧凸（CS）很有可能需要计划外手术，但很少有出版物报道计划外手术的比例、这些计划外手术的原因以及每种原因的患病率。本研究旨在提供有关上述内容的更多信息。我们回顾了2009年至2018年在我院接受计划外手术的CS患者的电子病历。通过检索华西医院数据库，我们找到了317例CS病例。其中，33例接受了计划外手术，其中5例在外医院进行了初次手术。在我们的病例系列中，计划外手术率为9.0%（28/312）。在我们的病例系列中，CS患者计划外手术的最常见原因是进行性畸形（49%，16/33），其次是植入物相关并发症（36%，12/33）、伤口相关并发症（12%，4/33）和手术失误相关并发症（脑脊液[CSF]漏，3%，1/33）。CS计划外手术最常见的原因是进行性脊柱畸形或失衡，占计划外手术的49%（16/33）。
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