2015年 · 第128卷第22期

Obstructive sleep apnea-hypopnea syndrome (OSAS) is associated with elevated liver enzymes and fatty liver. The purpose of this study was to measure serum liver enzyme levels in patients evaluated by polysomnography (PSG) and the factors associated with liver injury in OSAS patients.

All patients referred to PSG for evaluation of sleep apnea symptoms between June 2011 and November 2014 were included in this study. Demographic data and PSG parameters were recorded. Serum alanine aminotransferase, aspartate aminotransferase, and gamma-glutamyl transferase levels were systematically measured. OSAS patients were divided into mild, moderate, and severe groups according to the apnea-hypopnea index (AHI) values of 5–14 events/h, 15–29 events/h, and ≥30 events/h.

A total of 540 patients were enrolled in this study; among these patients, 386 were male. Elevated liver enzymes were present in 42.3% of OSAS patients (32.4% in mild/moderate group; 51.0% in severe group) and 28.1% patients without OSAS. Patients with OSAS had higher body mass index (BMI) (P < 0.01). In the bivariate correlation, the liver enzymes level was negatively correlated with age and the lowest arterial oxygen saturation (SaO₂), and was positively correlated with BMI, oxygen desaturation index, percent of total time with oxygen saturation level <90% (TS90%), AHI, total cholesterol (TC), and triglyceride (TG). In logistic regression analysis, Age, BMI, TS90%, TC, and TG were included in the regression equation.

Our data suggest that OSAS is a risk factor for elevated liver enzymes. The severity of OSAS is correlated with liver enzyme levels; we hypothesize that hypoxia is one of main causes of liver damage in patients with OSAS.

Attention-deficit hyperactivity disorder (ADHD) is the most common mental and behavioral disorder in school-aged children. This study evaluated the effect of osmotic-release oral system (OROS) methylphenidate (MPH) on cognitive function and academic performance of Chinese school-aged children with ADHD.

This 12-week, prospective, multicenter, open-label, self-controlled study enrolled 153 Chinese school-aged children with ADHD and 41 non-ADHD children. Children with ADHD were treated with once-daily OROS-MPH (18 mg, 36 mg, or 54 mg). The primary endpoints were Inattention/Overactivity (I/O) with Aggression Conners Behavior Rating Scale (IOWA) and Digit Span Test at week 12 compared with baseline. Secondary endpoints included opposition/defiant (O/D) subscale of IOWA, Clinical Global Impression (CGI), Coding Test, Stroop Color-word Test, Wisconsin Card Sorting Test (WCST), academic performance on teacher-rated school examinations, and safety at week 12 compared with baseline. Both non-ADHD and ADHD children received the same frequency of cognitive operational test to avoid the possible bias caused by training.

A total of 128 patients were evaluated with cognitive assessments. The OROS-MPH treatment significantly improved IOWA Conners I/O subscale scores at week 12 (3.8 ± 2.3) versus baseline (10.0 ± 2.4; P< 0.0001). Digit Span Test scores improved significantly (P < 0.0001) with a high remission rate (81.1%) at week 12 versus baseline. A significant (P < 0.0001) improvement was observed in O/D subscale of IOWA, CGI, Coding Test, Stroop Color-word Test, WCST, and academic performance at week 12 versus baseline. Very few practice-related improvements were noticed in the non-ADHD group at week 12 compared with baseline. No serious adverse events and deaths were reported during the study.

The OROS-MPH treatment effectively controlled symptoms of ADHD and significantly improved academic performance and cognitive function of Chinese school-aged children withADHD. The treatment was found to be safe and generally well-tolerated over 12 weeks.

ClinicalTrials.gov, NCT01933880; https://clinicaltrials.gov/ct2/show/NCT01933880?term=CONCERTAATT4099&rank=1

Preeclampsia (PE) is a serious idiopathic disease posing a threat to both mothers and fetuses’ lives during pregnancy, whose main diagnostic criteria include hypertension with proteinuria. However, American College of Obstetricians and Gynecologists (ACOG) updated the diagnostic criteria for PE and reduced the diagnostic value of proteinuria for patients with PE. Qualitative analysis of the diagnostic value of 24-h proteinuria for patients with PE in China was conducted to evaluate the diagnostic criteria value in the latest ACOG guideline.

Complete clinical data of 65 patients with hypertensive disorder in pregnancy (HDP) were collected. All patients were delivered to and hospitalized in Renji Hospital. Adverse outcome was defined in case of the emergence of any serious complication for a mother or the fetus. A retrospective study was conducted according to ACOG guideline, to analyze the relationship between each diagnostic criteria of ACOG guideline and maternal and perinatal outcomes. Spearman correlation test was used to detect the association between each diagnostic criterion, its corresponding value, and the adverse pregnancy outcome. Logistic regression was performed to verify the result of Spearman correlation test.

Of 65 HDP patients, the percentage of adverse pregnancy outcome was 63.1%. Adverse pregnancy outcomes constitute diversification. There were 55 cases with 24-h proteinuria value ≥0.3 g, of which the adverse outcome rate was 74.5%. While adverse pregnancy outcomes did not appear in the rest 10 HDP patients with proteinuria <0.3 g/24 h. The statistic difference was significant (P = 0.000). However, no significant difference was found in other criteria groups (impaired liver function: P= 0.417; renal insufficiency: P= 0.194; thrombocytopenia: P= 0.079; and cerebral or visual symptoms: P= 0.296). The correlation coefficient between 24-h proteinuria ≥0.3 g and adverse pregnancy outcomes was 0.557 (P < 0.005). Impaired liver function (P = 0.180), renal insufficiency (P = 0.077) and cerebral or visual symptoms (P = 0.118) were not related to adverse outcomes. The 24-h proteinuria value (HDP: r = 0.685; PE: r = 0.521), liver enzyme value (HDP: r = 0.519; PE: r = 0.501), and creatinine value (HDP: r = 0.511; PE: r = 0.398) were associated with adverse pregnancy outcomes both in PE and HDP, and the corresponding logistic regression equation can be produced.

The 24-h proteinuria value is still an important diagnostic criterion for PE, and deletion of 24-h proteinuria value from diagnostic criteria for severe PE was not recommended. The diagnostic criteria in ACOG guideline need to be verified in Chinese women.

The prevalence of malnutrition is very high in patients with cancer. The purpose of this study was to investigate whether or not a nutrition support team (NST) could benefit esophageal cancer patients undergoing chemoradiotherapy (CRT).

Between June 2012 and April 2014, 50 esophageal cancer patients undergoing concurrent CRT were randomly assigned into two groups: The NST group and the control group. The nutritional statuses of 25 patients in the NST group were managed by the NST. The other 25 patients in the control group underwent the supervision of radiotherapy practitioners. At the end of the CRT, nutritional status, the incidence of complications, and completion rate of radiotherapy were evaluated. Besides, the length of hospital stay (LOS) and the in-patient cost were also compared between these two groups.

At the completion of CRF, the nutritional status in the NST group were much better than those in the control group, as evidenced by prealbumin (ALB), transferrin, and ALB parameters (P = 0.001, 0.000, and 0.000, respectively). The complication incidences, including bone marrow suppression (20% vs. 48%, P= 0.037) and complications related infections (12% vs. 44%, P= 0.012), in the NST group were lower and significantly different from the control group. In addition, only one patient in the NST group did not complete the planned radiotherapy while 6 patients in the control group had interrupted or delayed radiotherapy (96% vs. 76%, P= 0.103). Furthermore, the average LOS was decreased by 4.5 days (P = 0.001) and in-patient cost was reduced to 1.26 ± 0.75 thousand US dollars person-times (P > 0.05) in the NST group.

A NST could provide positive effects in esophageal cancer patients during concurrent CRT on maintaining their nutrition status and improving the compliance of CRF. Moreover, the NST could be helpful on reducing LOS and in-patient costs.

Primary biliary cirrhosis (PBC) is a chronic and slowly progressive cholestatic liver disease characterized by destruction of the interlobular bile ducts and a striking female predominance. The aim of this study was to identify associations between estrogen receptor (ESR) gene polymorphisms with the risk of developing PBC and abnormal serum liver tests in a Chinese population.

Thirty-six patients with PBC (case group) and 35 healthy individuals (control group) from the First Hospital of Jilin University were studied. Whole genomic DNA was extracted from all the participants. Three single-nucleotide polymorphisms (rs2234693, rs2228480, and rs3798577) from ESR1 and two (rs1256030 and rs1048315) from ESR2 were analyzed by a pyrosequencing method. Demographic data and liver biochemical data were collected.

Subjects with the T allele at ESR2 rs1256030 had 1.5 times higher risk of developing PBC than those with the C allele (odds ratio [OR] = 2.1277, 95% confidence interval [CI] = 1.1872–4.5517). Haplotypes TGC of ESR1 rs2234693, rs2228480, and rs3798577 were risk factors for having PBC. The C allele at ESR1 rs2234693 was associated with abnormal alkaline phosphatase (OR = 5.2469, 95% CI = 1.3704–20.0895) and gamma-glutamyl transferase (OR = 3.4286, 95% CI = 1.0083–13.6578) levels in PBC patients.

ESR2 rs1256030 T allele may be a significant risk factor for the development of PBC. Screening for patients with gene polymorphisms may help to make early diagnoses in patients with PBC.

It is important to choose an appropriate antiepileptic drug (AED) to manage partial epilepsy. Traditional AEDs, such as carbamazepine (CBZ) and valproate (VPA), have been proven to have good therapeutic effects. However, in recent years, a variety of new AEDs have increasingly been used as first-line treatments for partial epilepsy. As the studies regarding the effectiveness of new drugs and comparisons between new AEDs and traditional AEDs are few, it is determined that these are areas in need of further research. Accordingly, this study investigated the long-term effectiveness of six AEDs used as monotherapy in patients with partial epilepsy.

This is a retrospective, long-term observational study. Patients with partial epilepsy who received monotherapy with one of six AEDs, namely, CBZ, VPA, topiramate (TPM), oxcarbazepine (OXC), lamotrigine (LTG), or levetiracetam (LEV), were identified and followed up from May 2007 to October 2014, and time to first seizure after treatment, 12-month remission rate, retention rate, reasons for treatment discontinuation, and adverse effects were evaluated.

A total of 789 patients were enrolled. The median time of follow-up was 56.95 months. CBZ exhibited the best time to first seizure, with a median time to first seizure of 36.06 months (95% confidential interval: 30.64–44.07). CBZ exhibited the highest 12-month remission rate (85.55%), which was significantly higher than those of TPM (69.38%, P= 0.006), LTG (70.79%, P= 0.001), LEV (72.54%, P= 0.005), and VPA (73.33%, P= 0.002). CBZ, OXC, and LEV had the best retention rate, followed by LTG, TPM, and VPA. Overall, adverse effects occurred in 45.87% of patients, and the most common adverse effects were memory problems (8.09%), rashes (7.76%), abnormal hepatic function (6.24%), and drowsiness (6.24%).

This study demonstrated that CBZ, OXC, and LEV are relatively effective in managing focal epilepsy as measured by time to first seizure, 12-month remission rate, and retention rate.

Autoimmune encephalitis associated with antibodies against γ-aminobutyric acid B receptor (GABA_BR) in patients with limbic encephalitis (LE) was first described in 2010. We present a series of Han Chinese patients for further clinical refinement.

Serum and cerebrospinal fluid (CSF) samples from patients referred to the program of encephalitis and paraneoplastic syndrome of Peking Union Medical College Hospital were tested with indirect immunofluorescence. Clinical information of patients with anti-GABA_BR antibody positivity was retrospectively reviewed, and descriptive statistical analysis was performed.

All eighteen anti-GABA_BR antibody-positive cases had limbic syndromes, and electroencephalogram (EEG) or neuroimaging evidence fulfilled the diagnostic criteria of LE. Four patients had additional antibodies against Hu in serum and one had anti-N-methyl-d-aspartate receptor antibody in both sera and CSF. Seventeen (17/18) patients presented with new-onset refractory seizure or status epileptics. Twelve (12/18) patients had memory deficits, 11 (11/18) patients had personality change, 7 (7/18) patients had disturbance of consciousness, and 3 (3/18) patients showed cerebellar dysfunction. One patient with LE had progressive motor and sensory polyneuropathy. Lung cancer was detected in 6 (6/18) patients. Ten (10/18) patients showed abnormality in bilateral or unilateral mediotemporal region on magnetic resonance imaging. Ten (10/18) patients had temporal lobe epileptic activity with or without general slowing on EEG. Seventeen patients received immunotherapy and 15 of them showed neurological improvement. Four patients with lung cancer died within 1–12 months due to neoplastic complications.

Our study demonstrates that most Han Chinese patients with anti-GABA_BR antibody-associated LE have prominent refractory epilepsy and show neurological improvement on immunotherapy. Patients with underlying lung tumor have a relatively poor prognosis. Testing for anti-GABA_BR antibodies is necessary for patients with possible LE or new-onset epilepsy with unknown etiology.

Oocyte vitrification is widely used throughout the world, but its clinical efficacy is inconsistent and depends on the vitrification media. This study compared the developmental potential and clinical results of in vivo matured oocytes cryopreserved with different vitrification media.

This retrospective study involved vitrified-warmed oocytes at one in vitro fertilization laboratory. Vitrification media kits comprised the MC kit (ethylene glycol [EG] plus 1,2-propanediol [PROH]), the KT kit (EG plus dimethyl sulphoxide [DMSO]), and the Modified kit (EG plus DMSO and PROH kit). Rates of oocyte survival and subsequent developmental potential were recorded and analyzed. The t-test and the Chi-square test were used to evaluate each method’s efficacy.

Oocyte survival rate was significantly higher for the Modified kit (92.0%) than for the MC kit (88.2%) (P < 0.05) and the KT kit (77.3%) (P < 0.001). The rate of high-quality embryo development in the Modified kit group (35.8%) was significantly higher than in the MC kit group (29.0%) and the KT kit group (28.3%) (P < 0.001). No significant differences were observed in the clinical pregnancy and implantation rates among the MC, KT, and Modified kit groups (37.2% vs. 30.2% vs. 39.6%; 21.9% vs. 18.8% vs. 27.4%, respectively) (P > 0.05). The high-quality embryo rate per warmed oocyte was significantly higher (23.4%) in the Modified kit group than in the other groups (P < 0.001). The embryo utilization and live birth rates per warmed oocyte were the highest in the Modified kit group, but not significantly (P > 0.05).

Modified vitrification media are efficient for oocyte vitrification and, with further verification, may be able to replace commercially available media in future clinical applications.

Open surgery is the preferred approach for the treatment of type D lesions according to the Trans-Atlantic Inter-Society Consensus (TASC) II guideline, but endovascular solutions also appear to be a valid option in selected patients. The study aimed to identify the risk factors of restenosis after open and endovascular reconstruction of symptomatic TASC II D aortoiliac occlusive lesions (AIOLs).

Fifty-six patients (82 limbs) who underwent open repair and endovascular treatment (ET) for symptomatic TASC ΙΙ D AIOLs between March 2005 and December 2012 were retrospectively reviewed. Baseline characteristics, preoperative and postoperative imaging, and operation procedure reports were reviewed and analyzed. Restenosis after revascularization was assessed by duplex ultrasound or computed tomography angiogram. Kaplan-Meier survival analysis, Log-rank test, and multivariate Cox regression were used to evaluate the relevance between risk factors and patency.

The mean duration of follow-up was 42.8 ± 23.5 months (ranging from 3 to 90 months). Primary patency rates at 1-, 3-, 5-, and 7-year were 93.6%, 89.3%, 87.0%, and 70.3%, respectively. Restenosis after revascularization occurred in 11 limbs. Kaplan-Meier survival analysis and the Log-rank test revealed that diabetes, Rutherford classification ≥5^th and concurrent femoropopliteal TASC II type C/D lesions were significantly related to the duration of primary patency. According to the result of Cox regression, diabetes and femoropopliteal TASC ΙΙ type C/D lesions were identified as the risk factors for restenosis after revascularization.

This study demonstrated that diabetes and femoropopliteal TASC ΙΙ type C/D lesions are risk factors associated with restenosis after open and ET of TASC II D AIOLs.

Intraperitoneal lymphangioma (IL) used to be thought of as a benign lymphatic malformation with a low rate of preoperative diagnosis. This retrospective study aimed to explore the connection between the cysts and clinical manifestation and imaging characteristics, and to study diagnostic confusion, therapeutic principles and potential recurrent reasons, to further enhance the comprehension of this rare disease.

Here, we retrospectively reviewed 21 patients diagnosed with IL. Age, sex, complaints, physical findings, and imaging features of each patient were documented. The therapies, postoperative complications and treatments were discussed.

Symptomatology included eight patients (38%) with intermittent dull pain in the abdomen, and three patients (14%) complained of abdominal persistent pain. The physical examination revealed an abdominal mass in 16 patients (76%), and eight (38%) were reported no discomfort. IL was correctly established preoperatively in 19 patients (90%). Patients were treated using laparotomy, except one who was treated with laparoscopy. Two recurrences were noted during follow-up.

IL should be suspected in any patient with a mobile abdominal mass and surgery is required immediately after discovery of the tumor.

Although Helicobacter pylori (H. pylori) is considered as the main etiological factor for gastric cancer, the strategy of screening and treating the oncogenic bacterium is still controversial. The objective was to evaluate the status and progress of the cognition about the relationship between H. pylori infection and gastric cancer from a clinical aspect.

The data used in this review were mainly from the PubMed articles published in English from 1984 to 2015.

Clinical research articles were selected mainly according to their level of relevance to this topic.

Gastric cancer is the fifth most common malignancy and the third leading cause of cancer deaths worldwide. The main etiological factor for gastric cancer is H. pylori infection. About 74.7–89.0% gastric cancer was related to H. pylori infection. Up to date, some regional gastric cancer prevention programs including the detection and treatment of H. pylori infection are under way. Current data obtained from the randomized controlled trials suggest that population-based H. pylori screening and treatment is feasible and cost-effective in preventing gastric cancer; however, a population-based H. pylori eradication campaign would potentially lead to bacterial resistance to the corresponding antibiotics, as well as a negative impact on the normal flora.

The important questions of feasibility, program costs, appropriate target groups for intervention, and the potential harm of mass therapy with antibiotics must first be answered before implementing any large-scale program.

Herpes zoster (HZ) is an acute virus infectious disease mainly affecting middle-aged and elderly people. The morbidity rates of HZ in the age group of 50–59 years and 60–69 years are, respectively, 46 and 69 (per year, per 10,000 people). The age groups of 70–79 years and 80–89 years have a much higher rate of 95 and 109 (per year, per 10,000 people), respectively.^[1,2]Postherpetic Neuralgia (PHN) is a neuropathic syndrome which manifests as ongoing pain along the cutaneous nerve/s located in the area of prior HZ rash and typically involves one or more of the following types of pain:_spontaneous aching or burning; paroxysmal shooting; and allodynia and hyperalgesia. While in the majority of cases, this pain will resolve within a year of initial rash presentation, for some patients the pain may persist for 5 years or more. As expected, given the relationship to HZ, the incidence of PHN increases markedly with age. However, the incidence is also linked to the severity of the pain experienced during the HZ episode. Those patients experiencing the highest levels of acute pain during HZ presentation are most at risk of developing PHN. PHN is also more prevalent among female than male HZ paitents.

Percutaneous nephrolithotomy (PCNL) has been the first-line treatment for renal staghorn calculi for many years. Several techniques have been described for percutaneous access and stone removal, but a multi-access approach is the mainstay of treatment. The main concern about PCNL is the resultant morbidity: Complications such as bleeding, parenchymal damage, and organ injury hindered the adoption of PCNL in primary hospitals in China. Multiple access points significantly increase the risk of bleeding, as well as the risks of other major complications. Although single access and flexible nephroscopy has been recommended as the most effective means of curing full staghorn stones, it is less popular as it is labor-intensive and time-consuming. In our opinion, the optimal strategy should be highly efficient and carry low risk, which requires new instruments. We have developed a semi-rigid nephroscope that integrates the function of rigid and flexible nephroscopes, and is manufactured in China by YouCare Technology Co., Ltd. It can be deployed with an ultrasonic or pneumatic lithotripsy system in rigid mode and a holmium laser in flexible mode, switching between the two is straightforward. We hope this nephroscope can achieve the goal of treating complete staghorn calculi efficiently and relatively noninvasively through a single access port. Herein, we report our experience of semi-rigid nephroscopic PCNL in the 1^styear of its use.

Neuromyelitis optica spectrum disease (NMOSD) refers to a group of related disease, in which potential pathogenesis is similar to neuromyelitis optica (NMO), but clinical involvement does not exactly correspond to the diagnosis of NMO. Owing to varied clinical manifestations, it is apt to be misdiagnosed. We report a case of NMOSD with cervical spondylosis and discuss the experience of diagnosis.

To the Editor: Only a small amount of studies were reported about paraurethral duct infection in males.^[1,2,3]To investigate the pathogens causing paraurethral duct infection and the secondary paraurethral duct dilation in males, and to understand the clinical characteristics and treatment options in paraurethral duct dilation, we retrospectively analyzed the data of male patients with paraurethral duct infection and subsequent paraurethral duct dilation who were treated at the Department of Dermatology of Changshu First People’s Hospital from January 2000 to October 2013.

To the Editor: Endobronchial ultrasound (EBUS) has been utilized as a useful noninvasive diagnostic tool for mediastinal lymph nodes or masses. Recently, convex probe EBUS (CP-EBUS) has recently come to be used to diagnose central pulmonary embolism.^[1,2,3]However, CP-EBUS cannot detect peripheral pulmonary embolism. It is here believed that the potential use of EBUS is still underestimated. Until now, there has been few reports showing whether radial probe EBUS (RP-EBUS) can detect peripheral pulmonary embolism. For this reason, we here report a case of a 60-year-old man admitted to our hospital because of enlarged mediastinal lymph nodes.

To the Editor: Spontaneous ureteral rupture is rare, and urolithiasis is the most common cause.^[1,2]The underlying mechanism may be the pressure around the ureteral wall due to stone impaction or a tear during the stone passage. Smaller distal stones exert higher intraureteral pressures than do larger proximal stones because of the greater length of obstructed ureter and the smaller diameter of the distal ureter.^[2]

To the Editor: A 65-year-old woman was admitted to Peking Union Medical College Hospital because of rash with pruritus for 1 month after taking Euthyrox. Rash attacked without other symptoms 20 days after she took Euthyrox 50 μg once a day and aggravated when Euthyrox was continued for the next 2 days. The past history included partial thyroidectomy for hyperthyroidism in 1982; tuberculosis in 1990; hypertension in 2009, and cerebral hemorrhage in 2010. It was noted that the patient occurred fever and vomiting 2–3 days after antituberculosis therapy, and the symptoms alleviated 3 days after rifampicin withdrawal. Penicillin skin test was positive. The laboratory examination showed thyroid-stimulating hormone 8.78 μU/ml (normal range: 0.38–4.34 μU/ml), T3, T4, FT3, and FT4 were normal, which suggested subclinical hypothyroidism. Patch test of Euthyrox was probable positive to 25–50 μg and positive to 100–150 μg at 48–72 h, while only probable positive to letrox 150 μg. Moreover, patch test of health control showed negative. Prick test was negative of two drugs. Hence, drug rash induced by Euthyrox was diagnosed according to the laboratory test results. The condition was stable 1 week after discontinuation of Euthyrox and rash disappeared completely after 1 month. Thyroid function returned to normal 4 months after taking Letrox and no rash reappeared.

To the Editor: Dermatopathic lymphadenitis (DL) represents a rare benign lymphatic hyperplasia commonly associated with exfoliative or eczematoid dermatitis. DL was also reported to be a potential mimicker of lymphoma.^[1]Here, we report the¹⁸F-fluorodeoxyglucose (¹⁸F-FDG) positron emission tomography/computer tomography (PET/CT) results and the histological findings of a 40-year-old female patient with DL.

To the Editor: In a single-center, prospective randomized clinical study including 122 elderly patients undergoing the carotid endarterectomy (CEA), Wanget al.^[1]showed that compared with propofol-based total intravenous anesthesia, low-dose sevoflurane inhalation along with propofol reduced the incidence of postoperative myocardial injury. Given the postoperative myocardial injury is a common cardiovascular adverse event and has been shown as an independent predictor of increased short-term mortality after noncardiac surgery, their findings have potential implications. We congratulate the authors for conducting this clinically useful research, but would like to ask some questions about their methodology.