2016年 · 第129卷第01期

Chinese Medical Journal (CMJ), founded in 1887 and the oldest medical journal in China, is one of our beloved journals. We began to read the journal from the days when we were medical students.

Evaluating a change in the screening rate for hepatocellular carcinoma (HCC) is critical for understanding screening implementation, and whether targeted population groups are receiving proper screening. This study examined recent nationwide changes in HCC screening use among hepatitis B virus (HBV)-infected populations after the introduction of the Korean National Cancer Screening Program and predictors of screening adherence.　

We analyzed 165 and 276 participants ≥40 years of age who were hepatitis B surface antigen-positive from 2001 (14,936 participants) to 2010–2011 (9159 participants) Korea National Health and Nutrition Examination Surveys, respectively. Demographic data, socioeconomic factors, and HCC screening use were collected by means of self-reported questionnaires.　

The rate of HCC screening within the previous 2 years increased significantly from 17.5% in 2001 to 40.3% in 2010– 2011 (P < 0.0001). The rate of HCC screening use increased from 2001 to 2010–2011 in all study populations. Subjects who had a higher income status and were aware of their infection were more likely to have undergone recent HCC screening.　

This study showed a substantial increase in HCC screening in high-risk HBV-infected subjects from 2001 to 2010–2011. However, the HCC screening participation rate remained suboptimal despite the introduction of the nationwide screening program. Efforts should be made to identify high-risk individuals and increase attendance at HCC screening events among high-risk groups.

Polypharmacy and potentially inappropriate medications (PIMs) are prominent prescribing issues in elderly patients. This study was to investigate the different prevalence of PIM use in elderly inpatients between 65–79 years of age and 80 years or older, who were discharged from Geriatric Department in West China Hospital.　

A large-scale cohort of 1796 inpatients aged 65 years or over was recruited. Respectively, 618 patients were 65–79 years and 1178 patients were 80 years or older. Updated 2012 Beers Criteria by the American Geriatric Society was applied to assess the use of PIM among the investigated samples.　

A review of the prescribed medications identified 686 patients aged 80 years or older consumed at least one PIM giving a rate of 58.2%. Conversely, 268 (43.4%) patients aged 65–79 years consumed at least one PIM (χ² = 40.18, P < 0.001). Patients aged 80 years or older had higher hospitalization expenses, length of stay, co-morbidities, medical prescription, and mortality than patients aged 65–79 years (all with P < 0.001). Patients aged 80 years or older were prescribed with more benzodiazepines, drugs with strong anticholinergic properties, megestrol, antipsychotics, theophylline, and aspirin. In multiple regression analysis, PIM use was significantly associated with female gender, age, number of diagnostic disease, and number of prescribed medication.　

The finding from this study revealed that inpatients aged 80 years or older encountered more PIM use than those aged 65–79 years. Anticholinergic properties, megestrol, antipsychotics, theophylline, and aspirin are medications that often prescribed to inpatients aged 80 years or older. Doctors should carefully choose drugs for the elderly, especially the elderly aged 80 years or older.

Mitochondrial dysfunction plays an important role in the pathogenesis of amyotrophic lateral sclerosis (ALS). We aimed to demonstrate mitochondrial dysfunction in ALS using a lactate stress test and to examine the relationship between mitochondrial dysfunction with motor deterioration.　

We enrolled 116 patients and observed clinical variables, including the survival state.　

Patients with a rapid slope of revised ALS functional rating scales (ALSFRS-r) (>20 U/year) exhibited the slowest elimination rate (median −4.67 × 10⁻³ mmol∙L⁻¹∙min⁻¹, coefficient of variation, 590.15%), the shortest duration (0.63 ± 0.28 years) and the worst ALSFRS-r (32.59 ± 4.93). Patients with a moderate slope of ALSFRS-r (10–20 U/year) showed a moderate elimination rate (median −11.33 × 10⁻³ mmol∙L⁻¹∙min⁻¹, coefficient of variation, 309.89%), duration (1.16 ± 0.45 years), and ALSFRS-r (34.83 ± 6.11). The slower progressing (<10 U/year group) patients exhibited a rapid elimination rate (median: −12.00 × 10⁻³ mmol∙L⁻¹∙min⁻¹, coefficient of variation: 143.08%), longer duration (median: 3 years, coefficient of variation: 193.33%), and adequate ALSFRS-r values (39.58 ± 9.44). Advanced-phase ALS patients also showed slower elimination rate (ER, quartiles −17.33, −5.67, 4.00) and worse ALSFRS-r (34.88 ± 9.27), while early-phase patients showed a more rapid ER (quartiles −25.17, −11.33, −3.50) and better ALSFRS-r (39.28 ± 7.59). These differences were statistically significant. Multiple linear regression analysis revealed strong direct associations among ER, ALSFRS-r slope (standard beta = 0.33, P = 0.007), and forced vital capacity (predict %) (standard beta = −0.458, P = 0.006, adjusted for ALSFRS-r, course and onset region). However, the data obtained from 3 years of follow-up showed no statistically significant difference in the survival rates between the most rapid and slowest ER groups.　

There is a potential linear relationship between ER and motor deterioration in ALS. Slower ER might be associated with faster disease progression.

The factors affecting the outcome of patients referred for lung transplantation (LTx) still have not been investigated extensively. The aim of this study was to characterize the patient outcomes and identify the prognostic factors for death while awaiting the LTx.　

From January 2003 to November 2013, the clinical data of 103 patients with end-stage lung disease that had been referred for LTx to Department of Thoracic Surgery, Shanghai Pulmonary Hospital were analyzed retrospectively. The relationship between predictors and survival was evaluated using the Kaplan–Meier method and the Cox proportional hazards model.　

Twenty-five patients (24.3%) died while awaiting the LTx. Fifty patients (48.5%) underwent LTx, and 28 patients (27.2%) were still on the waitlist. Compared to the candidates with chronic obstructive pulmonary disease (COPD), patients with idiopathic pulmonary fibrosis (IPF) had a higher mortality while awaiting the LTx (40.0% vs. 12.3%, P = 0.003). Patients requiring mechanical ventilation (MV) had a higher mortality while waiting than others (50.0% vs. 20.2%, P = 0.038). Two variables, using MV and IPF but not COPD as primary disease, emerged as significant independent risk factors for death on the waitlist (hazard ratio [HR]= 56.048, 95% confidence interval [CI]: 3.935–798.263, P = 0.003 and HR = 14.859, 95% CI: 2.695–81.932, P = 0.002, respectively).　

The type of end-stage lung disease, pulmonary hypertension, and MV may be distinctive prognostic factors for death while awaiting the LTx.

The dyschromatoses are a group of disorders characterized by simultaneous hyperpigmented macules together with hypopigmented macules. Dyschromatosis universalis hereditaria (DUH) and dyschromatosis symmetrica hereditaria are two major types. While clinical and histological presentations are similar in these two diseases, genetic diagnosis is critical in the differential diagnosis of these entities.　

Three patients initially diagnosed with DUH were included. The gene test was carried out by targeted gene sequencing. All mutations detected on ADAR1 and ABCB6 genes were analyzed according to the frequency in control database, the mutation types, and the published evidence to determine the pathogenicity.　

Family pedigree and clinical presentations were reported in 3 patients from two Chinese families. All patients have prominent cutaneous dyschromatoses involving the whole body without systemic complications. Different pathogenic genes in these patients with similar phenotype were identified: One novel mutation on ADAR1 (c. 1325C>G) and one recurrent mutation in ABCB6 (c. 1270T>C), which successfully distinguished two diseases with the similar phenotype.　

Targeted gene sequencing is an effective tool for genetic diagnosis in pigmentary skin diseases.

Laparoscopic liver resection (LLR) has been considered to be safe and feasible. However, few studies focused on the comparison between the anatomic and nonanatomic LLR. Therefore, the purpose of this study was to compare the perioperative factors and outcomes of the anatomic and nonanatomic LLR, especially the area of liver parenchymal transection and blood loss per unit area.　

In this study, surgical and oncological data of patients underwent pure LLR procedures for malignant liver tumor were prospectively collected. Blood loss per unit area of liver parenchymal transection was measured and considered as an important parameter. All procedures were conducted by a single surgeon.　

During nearly 5 years, 84 patients with malignant liver tumor received a pure LLR procedure were included. Among them, 34 patients received anatomic LLR and 50 received nonanatomic LLR, respectively. Patients of the two groups were similar in terms of demographic features and tumor characteristics, despite the tumor size was significantly larger in the anatomic LLR group than that in the nonanatomic LLR group (4.77 ± 2.57 vs. 2.87 ± 2.10 cm, P = 0.001). Patients who underwent anatomic resection had longer operation time (364.09 ± 131.22 vs. 252.00 ± 135.21 min, P < 0.001) but less blood loss per unit area (7.85 ± 7.17 vs. 14.17 ± 10.43 ml/cm², P = 0.018). Nonanatomic LLR was associated with more blood loss when the area of parenchymal transection was equal to the anatomic LLR. No mortality occurred during the hospital stay and 30 days after the operation. Moreover, there was no difference in the incidence of postoperative complications. The disease-free and overall survival rates showed no significant differences between the anatomic LLR and nonanatomic LLR groups.　

Both anatomic and nonanatomic pure LLR are safe and feasible. Measuring the area of parenchymal transection is a simple and effective method to estimate the outcomes of the liver resection surgery. Blood loss per unit area is an important parameter which is comparable between the anatomic LLR and nonanatomic LLR groups.

Etomidate (R-1-[1-ethylphenyl] imidazole-5-ethyl ester) is a widely used anesthetic drug that had been reported to contribute to cognitive deficits after general surgery. However, its underlying mechanisms have not been fully elucidated. In this study, we aimed to explore the neurobiological mechanisms of cognitive impairments that caused by etomidate.　

A total of 30 Sprague-Dawley rats were used and divided into two groups randomly to receive a single injection of etomidate or vehicle. Then, the rats’ spatial memory ability and neuronal survival were evaluated using the Morris water maze test and Nissl staining, respectively. Furthermore, we analyzed levels of oxidative stress, as well as cyclic adenosine 3’,5’-monophosphate response element-binding (CREB) protein phosphorylation and immediate early gene (IEG, including Arc, c-fos, and Egr1) expression levels using Western blot analysis.　

Compared with vehicle-treated rats, the etomidate-treated rats displayed impaired spatial learning (day 4: 27.26 ± 5.33 s vs. 35.52 ± 3.88 s, t = 2.988, P = 0.0068; day 5: 15.84 ± 4.02 s vs. 30.67 ± 4.23 s, t = 3.013, P = 0.0057; day 6: 9.47 ± 2.35 s vs. 25.66 ± 4.16 s, t = 3.567, P = 0.0036) and memory ability (crossing times: 4.40 ± 1.18 vs. 2.06 ± 0.80, t = 2.896, P = 0.0072; duration: 34.00 ± 4.24 s vs. 18.07 ± 4.79 s, t = 3.023, P = 0.0053; total swimming distance: 40.73 ± 3.45 cm vs. 27.40 ± 6.56 cm, t = 2.798, P = 0.0086) but no neuronal death. Furthermore, etomidate did not cause oxidative stress or deficits in CREB phosphorylation. The levels of multiple IEGs (Arc: vehicle treated rats 100%, etomidate treated rats 86%, t = 2.876, P = 0.0086; c-fos: Vehicle treated rats 100%, etomidate treated rats 72%, t = 2.996, P = 0.0076; Egr1: Vehicle treated rats 100%, etomidate treated rats 58%, t = 3.011, P = 0.0057) were significantly reduced in hippocampi of etomidate-treated rats.　

Our data suggested that etomidate might induce memory impairment in rats via inhibition of IEG expression.

Trichophyton rubrum represents the most common infectious fungus responsible for dermatophytosis in human, but the mechanism involved is still not completely understood. An appropriate model constructed to simulate host infection is the prerequisite to study the pathogenesis of dermatophytosis caused by T. rubrum. In this study, we intended to develop a new T. rubrum infection model in vitro, using the three-dimensional reconstructed epidermis - EpiSkin^®, and to pave the way for further investigation of the mechanisms involved in T. rubrum infection.　

The reconstructed human epidermis (RHE) was infected by inoculating low-dose (400 conidia) and high-dose (4000 conidia) T. rubrum conidia to optimize the infection dose. During the various periods after infection, the samples were processed for pathological examination and scanning electron microscopy (SEM) observation.　

The histological analysis of RHE revealed a fully differentiated epidermis with a functional stratum corneum, which was analogous to the normal human epidermis. The results of hematoxylin and eosin staining and the periodic acid-Schiff staining showed that the infection dose of 400 conidia was in accord with the pathological characteristics of host dermatophytosis caused by T. rubrum. SEM observations further exhibited the process of T. rubrum infection in an intuitionistic way.　

We established the T. rubrum infection model on RHE in vitro successfully. It is a promising model for further investigation of the mechanisms involved in T. rubrum infection.

Vascular endothelial growth factor (VEGF) in the thymus was mainly produced by the thymic epithelial cells (TECs), the predominant component of the thymic microenvironment. The progression of TECs and the roles of VEGF in the neonatal thymus during sepsis have not been reported. This study aimed to explore the alterations of TECs and VEGF level in the neonatal thymus involution and to explore the possible mechanisms at the cellular level.　

By establishing a model of clinical sepsis, the changes of TECs were measured by hematoxylin-eosin staining, confocal microscopy, and flow cytometry. Moreover, the levels of VEGF in serum and thymus were assessed based on enzyme-linked immunosorbent assay and Western blotting.　

The number of thymocytes and TECs was significantly decreased 24 h after lipopolysaccharide (LPS) challenge, (2.40 ± 0.46)×10⁷ vs. (3.93 ± 0.66)×10⁷ and (1.16 ± 0.14)×10⁵ vs. (2.20 ± 0.19)×10⁵, P < 0.05, respectively. Cortical TECs and medullary TECs in the LPS-treated mice were decreased 1.5-fold and 3.9-fold, P < 0.05, respectively, lower than those in the controls. The number of thymic epithelial progenitors was also decreased. VEGF expression in TECs was down-regulated in a time-dependent manner.　

VEGF in thymic cells subsets might contribute to the development of TECs in neonatal sepsis.

Postmastectomy pain syndrome (PMPS) is defined as a chronic (continuing for 3 or more months) neuropathic pain affecting the axilla, medial arm, breast, and chest wall after breast cancer surgery. The prevalence of PMPS has been reported to range from 20% to 68%. In this study, we aimed to determine the prevalence of PMPS among mastectomy patients, the severity of neuropathic pain in these patients, risk factors that contribute to pain becoming chronic, and the effect of PMPS on life quality.　

This cross-sectional study was approved by the Sakarya University, Medical Faculty Ethical Council and included 146 patients ranging in age from 18 to 85 years who visited the pain clinic, general surgery clinic, and oncology clinic and had breast surgery between 2012 and 2014. Patients were divided into two groups according to whether they met PMPS criteria: pain at axilla, arm, shoulder, chest wall, scar tissue, or breast at least 3 months after breast surgery. All patients gave informed consent prior to entry into the study. Patient medical records were collected, and pain and quality of life were evaluated by the visual analog scale (VAS) for pain, a short form of the McGill Pain Questionnaire (SF-MPQ), douleur neuropathique-4 (DN-4), and SF-36.　

Patient mean age was 55.2 ± 11.8 years (33.0–83.0 years). PMPS prevalence was 36%. Mean scores on the VAS, SF-MPQ, and DN-4 in PMPS patients were 1.76 ± 2.38 (0–10), 1.73 ± 1.54 (0–5), and 1.64 ± 2.31 (0–8), respectively. Of these patients, 31 (23.7%) had neuropathic pain characteristics, and 12 (9.2%) had phantom pain according to the DN-4 survey. Patients who had modified radical mastectomy were significantly more likely to develop PMPS than patients who had breast-protective surgery (P = 0.028). Only 2 (2.4%) of PMPS patients had received proper treatment (anticonvulsants or opioids).　

PMPS seriously impacts patients’ emotional situation, daily activities, and social relationships and is a major economic burden for health systems. We conclude that the rate of PMPS among patients receiving breast cancer surgery in Turkey is 64.1% and that challenges to the proper treatment of these patients deserve further investigation.

Despite the rapid growth in the incidence of acute myocardial infarction (AMI) in China, there is limited information about patients’ experiences after AMI hospitalization, especially on long-term adverse events and patient-reported outcomes (PROs).　

The China Patient-centered Evaluative Assessment of Cardiac Events (PEACE)-Prospective AMI Study will enroll 4000 consecutive AMI patients from 53 diverse hospitals across China and follow them longitudinally for 12 months to document their treatment, recovery, and outcomes. Details of patients’ medical history, treatment, and in-hospital outcomes are abstracted from medical charts. Comprehensive baseline interviews are being conducted to characterize patient demographics, risk factors, presentation, and healthcare utilization. As part of these interviews, validated instruments are administered to measure PROs, including quality of life, symptoms, mood, cognition, and sexual activity. Follow-up interviews, measuring PROs, medication adherence, risk factor control, and collecting hospitalization events are conducted at 1, 6, and 12 months after discharge. Supporting documents for potential outcomes are collected for adjudication by clinicians at the National Coordinating Center. Blood and urine samples are also obtained at baseline, 1- and 12-month follow-up. In addition, we are conducting a survey of participating hospitals to characterize their organizational characteristics.　

The China PEACE-Prospective AMI study will be uniquely positioned to generate new information regarding patient’s experiences and outcomes after AMI in China and serve as a foundation for quality improvement activities.

To examine the efficacy and safety of dual blockade of the renin-angiotensin-aldosterone system (RAAS) among patients with type 2 diabetic kidney disease.　

We searched the major literature repositories, including the Cochrane Central Register of Controlled Trials, MEDLINE and EMBASE, for randomized clinical trials published between January 1990 and October 2015 that compared the efficacy and safety of the use of dual blockade of the RAAS versus the use of monotherapy, without applying any language restrictions. Keywords for the searches included "diabetic nephropathy," "chronic kidney disease," "chronic renal insufficiency," "diabetes mellitus," "dual therapy," "combined therapy," "dual blockade," "renin-angiotensin system," "angiotensin-converting enzyme inhibitor," "angiotensin-receptor blocker," "aldosterone blockade," "selective aldosterone blockade," "renin inhibitor," "direct renin inhibitor," "mineralocorticoid receptor blocker," etc.　

The selected articles were carefully reviewed. We excluded randomized clinical trials in which the kidney damage of patients was related to diseases other than diabetes mellitus.　

Combination treatment with an angiotensin-converting enzyme inhibitor supplemented by an angiotensin II receptor blocking agent is expected to provide a more complete blockade of the RAAS and a better control of hypertension. However, existing literature has presented mixed results, in particular, related to patient safety. In view of this, we conducted a comprehensive literature review in order to explain the rationale for dual blockade of the RAAS, and to discuss the pros and cons.　

Despite the negative results of some recent large-scale studies, it may be immature to declare that the dual blockade is a failure because of the complex nature of the RAAS surrounding its diversified functions and utility. Further trials are warranted to study the combination therapy as an evidence-based practice.

Osteogenesis imperfecta (OI), also known as brittle bone disease or Lobstein syndrome, is characterized by blue or gray sclerae, variable short stature, dentinogenesis imperfecta, hearing loss, and recurrent fractures. Based on clinical, genetic, and radiological features, Sillenceet al.^[1]classified the OI into four subtypes including type I: Mild, common, with blue sclera; type II: Perinatal lethal form; type III: Severe and age-related progressive deformity, with normal sclera; and type IV: Moderate severity with normal sclera. Based on mutated genes and inheritance patterns, the four subtypes are further classified into 15 types of OI in Online Mendelian Inheritance in Man. More than 90% of the patients with OI have mutations in collagen type I alpha (COL1A) 1 andCOL1A2.^[2]

The conventional total knee arthroplasty (TKA) is the most successful surgical procedure for relieving pain and improving poor function in patients with advanced arthritis. However, postoperative pain and delayed rehabilitation are the greatest complaints for the conventional approach. Recently, various minimally invasive surgery (MIS) TKA-techniques have been developed to address the concern. MIS-TKAs have shown less postoperative pain, shorter hospital stays, and quicker recovery after surgery.

The practice of artificial tracheal prosthesis has been a major challenge to the entire surgical field worldwide until now. The previously applied prosthesis is "inner stent" type, which is unable to heal biologically with native trachea.^[1]The newly developed design, the Zhao’s artificial trachea, uses a memory alloy mesh combined with traditional operation procedures. Following a 2-year experimental period, the device has been applied to seven patients with satisfying results. We believe this to be a successful artificial trachea that is capable of complete biologically healing with the native trachea. No rejection, infection, or major complications were present in the seven patients, and the Zhao’s artificial trachea may be considered a real part of the trachea.

Bile acid synthetic defect (BASD) is a rare category of genetic disorders that are responsible for approximately 2% of persistent cholestasis in infants.^[1]Until date, four enzymes responsible for congenital defects of bile acid synthesis (CBAS) have been identified. 3β-hydroxy-∆5-C27-steroid dehydrogenase (3β-HSD), the deficiency of which can cause CBAS1 (OMIM No. 607765), is encoded by the geneHSD3B7and works in the second step of transforming the steroid into primary bile acids.

In current catheter research, there are 3 main directions with respect to fractional flow reserve (FFR), including instantaneous wave-free ratio, noninvasive measurement of FFR, and FFR transferred from coronary circulation to other ischemia-inducing circulation. Recently, an interesting study was published, in which FFR was performed to diagnose and guide stenting in chronic mesenteric ischemia (CMI).^[1]We herein highlighted, the implications and limitations of FFR from coronary artery to renal artery and mesenteric artery for future investigations, respectively.

Adolescent idiopathic scoliosis (AIS) is one of the most prevalent diseases among teenagers, with an incidence rate of 1–3% worldwide, and at least 0.02% of patients require surgical treatment.^[1]The "gold standard" procedure is instrumentation and fusion of 10 or more vertebrae with forceful correction of the deformity.^[2]Although autogenous bone grafts are the "gold standard" for spine fusion,^[3]significant progress has been made in discovering bone graft alternatives, including freeze-dried allograft, demineralized bone matrix (DBM), triosite ceramics, and bone marrow aspirate (BMA), which have been used as substitutes for iliac crest in AIS surgery.^[4,5,6,7]Results show that these substitutes could gain similar benefits for spine fusion, while other evidences fail to be replicated. Orthopedic surgeons are put into a dilemma of which substitute is the best for AIS surgery with less complications while achieving higher fusion rate. In this article, we presented our viewpoint on this issue.

To the Editor: A 20-year-old woman complained of two painful pruritic lesions on her left index finger. She had been bitten by a lamb on her index finger a month earlier; the lamb died 2 days later. Five days after having been bitten, she noticed two papules on her left index finger that enlarged gradually. Physical examination revealed two indurated nodules 8-mm and 10-mm in diameter, each with central umbilication and surrounded by a reddish halo [Figure 1a]. The patient had no fever, respiratory symptoms, or lymphadenopathy. The informed consent was written.

To the Editor: SAPHO syndrome is a heterogeneous disorder characterized by synovitis, acne, pustulosis, hyperostosis, and osteitis. Its diagnosis can be difficult if there are no typical skin manifestations. We reported a case of SAPHO syndrome which also fulfills the current diagnostic criteria, for ankylosing spondylitis (AS).

To the Editor: Double aortic arch (DAA), a rare congenital cardiovascular disorder, is usually diagnosed and surgically corrected at an early age due to dyspnea or dysphagia caused by an obstruction of trachea or esophagus.^[1]Here, we report a case with DAA and a dissecting aneurysm, which was successfully performed by stent-assisted coiling.

To the Editor:Nocardiaspecies are Gram-positive partially acid-fastBacillithat are found in soil and water. Nocardial brain abscess is rare but carries a high fatality rate, and there is controversy in literature whether these lesions should be routinely excised or simply aspirated.^[1]The first case ofNocardia crassostreaebrain abscess in a 31-year-old immunocompetent male is reported here to highlight this emerging pathogen and the antimicrobial sensitivity. He presented with a 1-week history of progressive right hemiparesis. He regularly swam in the open sea and had a cut on his right big toe while swimming. His temperature was 36.2°C. He was alert and orientated with grade 4 Medical Research Council weakness in the right upper limb and grade 2 in the right lower limb, with brisk (3+) reflexes. The magnetic resonance imaging (MRI) of the brain showed an abscess [Figure 1a]. His white blood count including lymphocytes with differentials was normal, and blood cultures were negative. He had a normal chest radiograph.

To the Editor: In their meta-analysis, Maet al.^[1]aimed to determine the association of mortality with hydroxyethyl starch 130/0.4 or 0.42 (HES) with HES dose and daily fluid balance in sepsis patients. Sensitivity tests were performed to analyze reasons for heterogeneity in mortality data. These tests focused on "risk of bias."

Dr. Wiedermann commented on our systematic review and meta-regression for the sources of heterogeneity in trials reporting HES 130/0.4 or 0.42 associated excess mortality in septic patients^[1]that the pooled analysis of mortality, which showed neither benefit nor harm, might be influenced by trials of low-quality. Statistically, we agree with this conclusion if two of the recruited trials judged as the intermediate risk of bias are precluded.

In the article titled, "Clinical Efficacy of Oral Ganciclovir for Prophylaxis and Treatment of Recurrent Herpes Simplex Keratitis" published in pages 46-50, issue 1, vol. 128 ofChinese Medical Journal^[1], the affiliation of the second author "Linnong Wang" and third author "Xinjun Ma" is written incorrectly as "Department of Ophthalmology, Nanjing First People’s Hospital, Nanjing, Jiangsu 210006, China" instead of "Department of Ophthalmology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu 210006, China" .