2016年 · 第129卷第16期

On June 13, 2016, the US congress passed the bill H. Res. 343 based on the false statements regarding organ transplantation in China, which indicated serious miscommunication and misjudgment between China and the US on the issue. The bill is preceded and followed by a series distorted media reports by the Cable News Network and the New York Times.^[1,2]It is a typical act of demonizing China with colored glasses that boldly ignored the facts and fabricated the evidence for political purposes.

The efficacy and safety of telmisartan combined with clopidogrel, leflunomide, or both drugs for immunoglobulin A nephropathy (IgAN) are unclear. This study was designed to evaluate the efficacy and safety of telmisartan combined with clopidogrel, leflunomide, or both drugs for IgAN.

It is a multicenter, prospective, double-dummy randomized controlled trial. Primary IgAN patients were recruited in 13 renal units across Beijing, China, from July 2010 to June 2012. After a 4-week telmisartan (80 mg/d) wash-in, 400 patients continuing on 80 mg/d telmisartan were randomly assigned to additionally receive placebo (Group A), 50 mg/d clopidogrel (Group B), 20 mg/d leflunomide (Group C), or 50 mg/d clopidogrel and 20 mg/d leflunomide (Group D). The 24-week intervention was completed by 360 patients. The primary endpoint was change in 24-h proteinuria at 24 weeks. A linear mixed-effect model was used to analyze the changes at 4, 12, and 24 weeks. Generalized estimating equations were used to evaluate changes in hematuria grade. This trial was registered at the Chinese Clinical Trial Registry.

The effects of telmisartan combined with leflunomide on changes in proteinuria (0.36 [95% confidence interval (CI) 0.18–0.55] g/d, P < 0.001), in serum uric acid (76.96 [95% CI 57.44–96.49] µmol/L, P < 0.001), in serum creatinine (9.49 [95% CI 6.54–12.44] µmol/L, P < 0.001), and in estimated glomerular filtration rate (-6.72 [95% CI -9.46 to -3.98] ml∙min^-1∙1.73 m^-2, P < 0.001) were statistically significant, whereas they were not statistically significant on changes in systolic and diastolic blood pressure and weight (P > 0.05). Telmisartan combined with clopidogrel had no statistical effect on any outcome, and there was no interaction between the interventions. No obvious adverse reactions were observed.

Telmisartan combined with leflunomide, not clopidogrel, is safe and effective for decreasing proteinuria in certain IgAN patients.

chictr.org.cn, ChiCTR-TRC-10000776; http://www.chictr.org.cn/showproj.aspx?proj=8760.

Current risk stratification of idiopathic dilated cardiomyopathy (IDC) lacks sufficient sensitivity and specificity. The objective of this study was to investigate the predictive role of frontal QRS-T angles in IDC.

A prospective study with 509 IDC patients was performed from February 2008 to December 2013 in the Affiliated Drum Tower Hospital, Nanjing University School of Medicine. Baseline values and changes in QRS-T angles were recorded. Follow-up was conducted every 6 months. Analyses by Cox Proportional Hazards model were performed to evaluate the association between QRS-T angle and outcomes. The primary outcome of interest was all-cause mortality.

During a median follow-up of 34 months, 90 of 316 patients with QRS-T angles >90° died compared to 31 of 193 patients with QRS-T angles ≤90° (hazard ratio [HR] =2.4, P < 0.001). Cardiac death was more prevalent in patients with a wide QRS-T angle (HR = 2.4, P < 0.001), similar to heart failure rehospitalization (HR = 2.5, P < 0.001). After adjustment for potential prognostic factors, the QRS-T angle was independently associated with all-cause mortality (HR = 2.5, P < 0.05), cardiac mortality (HR = 1.9, P < 0. 05), and heart failure rehospitalization (HR = 2.3, P < 0.01). Optimized therapy significantly narrowed the frontal QRS-T angle (100.9 ± 53.4° vs. 107.2 ± 54.4°, P < 0.001). The frontal QRS-T angle correlated well with established risk factors, such as left ventricular ejection fraction, brain natriuretic peptide, and New York Heart Association functional class.

The frontal QRS-T angle is a powerful predictor of all-cause mortality, cardiac mortality, and worsening heart failure in IDC patients, independent of well-established prognostic factors. Optimized therapy significantly narrows the QRS-T angle, which might be an indicator of medication compliance, but this requires further investigation.

For a child with osteosarcoma, prediction of the limb length discrepancy at maturity is important when planning for limb salvage surgery. The purpose of this study was to provide a reliable prediction method.

A retrospective review of Chinese children receiving chemotherapy for osteosarcoma before skeletal maturity was conducted. Standing full-length radiographs of the lower extremity were used for length measurements. Length-for-age curves were constructed using the LMS method. The lower limb multiplier for a specific age and gender was calculated using the formula M = L_m/L, where M was the gender- and age-specific multiplier, L_m was the bone length at maturity, and L was the age-specific bone length. Prematurity and postmaturity radiographs were used to assess the accuracy of the prediction methods.

A total of 513 radiographs of 131 boys and 314 radiographs of 86 girls were used to calculate the coefficients of the multiplier. The multipliers of 8-, 9-, 10-, 11-, 12-, 13-, 14-, 15-, 16-, 17-, and 18-year-old boys after chemotherapy for osteosarcoma were 1.394, 1.306, 1.231, 1.170, 1.119, 1.071, 1.032, 1.010, 1.004, 1.001, and 1.000, respectively; while for girls at the same ages, the multipliers were 1.311, 1.221, 1.146, 1.092, 1.049, 1.021, 1.006, 1.001, 1.000, 1.000, and 1.000, respectively. Prematurity and postmaturity femoral and tibial lengths of 21 patients were used to assess the prediction accuracy. The mean prediction error was 0 cm, 0.8 cm, and 1.6 cm for the multiplier method using our coefficients, Paley’s coefficients, and Anderson’s method, respectively.

Our coefficients for the multiplier method are reliable in predicting lower limb length growth of Chinese children with osteosarcoma.

Infection and aseptic loosening are common complications of total elbow arthroplasty (TEA) and often require revision surgery. However, bone defects, along with other complications, bring an extra difficulty to the second surgery, especially for patients with a massive bone defect in the proximal ulna. Several methods including allograft or autograft have been introduced into practice, but none sufficiently solves these problems.

We conducted a new surgical method for patients with a massive ulnar bone defect needing revision TEA. During revision arthroplasty, the ulnar prosthesis was inserted into the radius as a salvage procedure. Four consecutive patients received revision arthroplasty with this method between 2013 and 2016. Patients’ data were collected to evaluate the clinical outcome.

All patients had a Grade III ulnar bone defect. At the last follow-up session, all patients reported a painless, functional elbow joint. Three patients suffered from a periprosthetic infection that was completely cured using the two-stage method. No major complications, including infection, aseptic loosening, or wound problems were found. One patient had a transient ulnar neuritis, and another had a transient radial neuritis. Both patients had full recovery at the last follow-up session.

Inserting an ulnar prosthesis into the radius is a novel procedure for patients with a massive bone defect due to infection or aseptic loosening. It is a safe, quick, and effective treatment with a promising short-term outcome. This method should be provided as a salvage procedure for patients with a nonreconstructable ulnar bone defect.

The cognitive function of children with either attention deficit hyperactivity disorder (ADHD) or learning disabilities (LDs) is known to be impaired. However, little is known about the cognitive function of children with comorbid ADHD and LD. The present study aimed to explore the cognitive function of children and adolescents with ADHD and learning difficulties in comparison with children with ADHD and healthy controls in different age groups in a large Chinese sample.

Totally, 1043 participants with ADHD and learning difficulties (the ADHD + learning difficulties group), 870 with pure ADHD (the pure ADHD group), and 496 healthy controls were recruited. To investigate the difference in cognitive impairment using a developmental approach, all participants were divided into three age groups (6–8, 9–11, and 12–14 years old). Measurements were the Chinese-Wechsler Intelligence Scale for Children, the Stroop Color-Word Test, the Trail-Making Test, and the Behavior Rating Inventory of Executive Function-Parents (BRIEF). Multivariate analysis of variance was used.

The results showed that after controlling for the effect ofADHD symptoms, theADHD + learning difficulties group was still significantly worse than the pureADHD group, which was, in turn, worse than the control group on full intelligence quotient (98.66 ± 13.87 vs. 105.17 ± 14.36 vs. 112.93 ± 13.87, P < 0.001). The same relationship was also evident for shift function (shifting time of the Trail-Making Test, 122.50 [62.00, 194.25] s vs. 122.00 [73.00, 201.50] s vs. 66.00 [45.00, 108.00] s, P < 0.001) and everyday life executive function (BRIEF total score, 145.71 ± 19.35 vs. 138.96 ± 18.00 vs. 122.71 ± 20.45, P < 0.001) after controlling for the effect of the severity of ADHD symptoms, intelligence quotient, age, and gender. As for the age groups, the differences among groups became nonsignificant in the 12–14 years old group for inhibition (meaning interference of the Stroop Color-Word Test, 18.00 [13.00, 25.00] s vs. 17.00 [15.00, 26.00] s vs. 17.00 [10.50, 20.00] s, P = 0.704) and shift function (shifting time of the Trail-Making Test, 62.00 [43.00, 97.00] s vs. 53.00 [38.00, 81.00] s vs. 101.00 [88.00, 114.00] s, P = 0.778).

Children and adolescents with ADHD and learning difficulties have more severe cognitive impairment than pure ADHD patients even after controlling for the effect of ADHD symptoms. However, the differences in impairment in inhibition and shift function are no longer significant when these individuals were 12–14 years old.

Onychomycosis is a fungal infection of the nail plate and subungual area. In this study, we examined the efficacy of laser treatment using self-controlled study programs involving a long-pulsed Nd:YAG 1064-nm laser combined with oral medication.

Self-controlled strategies were followed in this study. The patients received treatment with oral itraconazole in conjunction with long-pulsed Nd:YAG 1064-nm laser treatment at the nails of the unilateral limb once a week for a total of four times. A total of 84 affected nails were divided into Group A (mild to moderate) and Group B (severe) according to disease severity. Affected nails with the same Scoring Clinical Index for Onychomycosis scores were selected to compare the therapeutic effects of the pure medication treatment group and the combination treatment group with a 24-week follow-up period.

In Group A, at the 8^th, 16^th, and 24^th weeks of follow-up, the efficacies in the pure medication treatment group were 81.0%, 81.0%, and 90.5%, respectively, while those in the combination treatment group were 100%, 95.2%, and 90.5%, respectively. The differences between groups were not significant (8^th week: χ² = 4.421, P > 0.05; 16^th week: χ² = 2.043, P > 0.05; 24^th week: χ² = 0.00, P > 0.05). In Group B, at the 8^th, 16^th, and 24^th weeks of follow-up, the efficacies in the pure medication treatment group were 61.9%, 66.7%, and 52.4%, respectively, while those in the combination treatment group were 95.2%, 90.5%, and 100%, respectively. The differences between groups at the 8^th and 24^th weeks of follow-up were statistically significant (8^th week: χ² = 6.929, P < 0.05; 24^th week: χ² = 13.125, P < 0.05).

For patients with mild or moderate onychomycosis, we recommended a pure medication treatment or combination treatment with medication and laser. For those patients with severe onychomycosis, we recommended a combination of medication and laser therapy.

Pediatric dental fear, if left unchecked, can persist for a lifetime and adversely impact the physical and psychological health of a patient. In this study, a feasible nonmedical method for relieving pediatric dental fear was investigated.

A randomized, single-blind, controlled trial model was applied. The juvenile patients experiencing dental fear, whose parents or guardian had signed an informed consent form, were randomly divided into two groups. Group A (n = 50) was the control group, while Group B (n = 50) was the reward group. Participants in Group A accepted routine treatment. Participants in Group B were told that they would obtain a gift as a reward for their good behavior if they were compliant during their dental treatments. The Chinese version of the Children’s Fear Survey Schedule-Dental Subscale (CFSS-DS) was used to evaluate the level of dental fear of each patient both before and after each treatment. A contrast analysis and a correlation analysis of the results were used to assess the efficacy of the reward mechanism.

All participants in Group B, were obedient during the dental treatment, and they also successfully chose the present they wanted at the end of their dental treatment. Children at different ages showed different reward preferences. Significant difference in the fear scores of the participants in Group B before the treatment and after receiving the reward was found (independent samples t-test, t = 14.72, P < 0.001). In Group A, 86% children’s fear score did not undergo a noticeable change.

A reward system is proved feasible to relieve pediatric dental fear, and the form of reward should meet the demand of patients.

Acute diarrhea remains the serious problem in developing countries, especially among children under 5 years of age. Currently, only two or three common diarrhea pathogens were screened at most hospitals in China. The aim of this study was to provide a wide variety of diarrhea pathogens and their antimicrobial resistance patterns in children under 5 years of age.

Totally 381 stool samples collected from Tongji Hospital between July 1, 2014 and June 30, 2015 were tested by culture and/or polymerase chain reaction for eight kinds of bacteria and five kinds of viruses. An antimicrobial sensitivity test was performed using dilution method recommended by the Clinical and Laboratory Standards Institute.

Viral infections were mainly identified in infants (0–11 months), whereas bacterial infections were more prevalent in the age of 24–59 months. About 69.8% of samples were positive for at least one pathogen, 51.7% of samples were virus positive, followed by bacteria positive cases (19.4%), and 12.6% of cases displayed co-infections with two viruses or a virus and a bacterium. Rotavirus was the most prevalent pathogen, followed closely by norovirus, while Salmonella was the most commonly isolated bacteria, followed by diarrheagenic Escherichia coli (DEC) and Campylobacter. More than 40% of Salmonella spp. and DEC isolates were resistant to first-line antibiotics (ampicillin, trimethoprim-sulfamethoxazole, and tetracycline). Around 10% of Salmonella spp. isolates were resistant to ceftriaxone and ciprofloxacin simultaneously. Campylobacter spp. displayed high resistance to ciprofloxacin but kept low resistance to azithromycin and doxycycline.

The etiology of acute diarrhea varies in children of different age groups. The high frequency of infection with viruses suggests the urgent demand for new viral vaccine development. Proper use of antibiotics in the treatment of acute diarrhea is crucial due to the high level of antibiotic resistance.

Mitochondrial diseases are a group of energy metabolic disorders with multisystem involvements. Variable clinical features present a major challenge in pediatric diagnoses. We summarized the clinical spectrum of m.3243A>G mutation in Chinese pediatric patients, to define the common clinical manifestations and study the correlation between heteroplasmic degree of the mutation and clinical severity of the disease.

Clinical data of one-hundred pediatric patients with symptomatic mitochondrial disease harboring m.3243A>G mutation from 2007 to 2013 were retrospectively reviewed. Detection of m.3243A>G mutation ratio was performed by polymerase chain reaction (PCR)-restriction fragment length polymorphism. Correlation between m.3243A>G mutation ratio and age was evaluated. The differences in clinical symptom frequency of patients with low, middle, and high levels of mutation ratio were analyzed by Chi-square test.

Sixty-six patients (66%) had suffered a delayed diagnosis for an average of 2 years. The most frequent symptoms were seizures (76%), short stature (73%), elevated plasma lactate (70%), abnormal magnetic resonance imaging/computed tomography (MRI/CT) changes (68%), vomiting (55%), decreased vision (52%), headache (50%), and muscle weakness (48%). The mutation ratio was correlated negatively with onset age (r = -0.470, P < 0.001). Myopathy was more frequent in patients with a high level of mutation ratio. However, patients with a low or middle level of m.3243A>G mutation ratio were more likely to suffer hearing loss, decreased vision, and gastrointestinal disturbance than patients with a high level of mutation ratio.

Our study showed that half of Chinese pediatric patients with m.3243A>G mutation presented seizures, short stature, abnormal MRI/CT changes, elevated plasma lactate, vomiting, and headache. Pediatric patients with these recurrent symptoms should be considered for screening m.3243A>G mutation. Clinical manifestations and laboratory abnormalities should be carefully monitored in patients with this point mutation.

Angiogenesis is the formation of new blood vessels to supply nutrients to tumors. Vascular endothelial growth factor (VEGF) and cluster of differentiation 34 (CD34) are important signaling proteins involved in angiogenesis. Many studies have demonstrated that VEGF and CD34 are related to tumor progression. This study focused on the relationship between VEGF, CD34, and perioperative hemorrhage in patients with gastric cancer.

To observe the relationship between VEGF and CD34, we tracked 112 patients with advanced gastric cancer for 5 years to assess factors related to hemorrhage, using immunohistochemistry. The results were subjected to statistical analysis using a 2 × 2 contingency table, logistic regression, and receiver operating characteristic (ROC) test.

The concentrations of VEGF and CD34 were critically correlated with perioperative hemorrhage and neural invasion in patients with gastric cancer (P < 0.05). Expression of VEGF and CD34 was related (P < 0.05, χ² = 6.834). VEGF and CD34 co-expression strongly increased the risk of preoperative bleeding (area under the ROC curve >0.7, P < 0.05).

Expression of VEGF and CD34 was critically correlated with perioperative hemorrhage in gastric cancer patients. Co-expression of VEGF and CD34 could be an effective indicator for evaluating the risk of perioperative bleeding in gastric cancer patients.

The previous studies agree that minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) has better function outcomes, less blood loss, and shorter hospital stay, when compared to open-TLIF. However, there are no significance differences on operative time, complication, and reoperation rate between the two procedures. This could be from less relative literatures and lower grade evidence. The further meta-analysis is needed with more and higher grade evidences to compare the above two TLIF procedures.

Prospective and retrospective studies that compared open-TLIF and MIS-TLIF were identified by searching the Medline, Embase, Web of Science, China National Knowledge Infrastructure, Wanfang, and VIP database (the literature search comprised Medical Subject Heading terms and key words or Emtree term). The retrieval time ranged from the date when the database was founded to January 2015. Pooled risk ratios (RRs) and weighted mean differences (WMDs) with 95% confidence intervals were calculated for the clinical outcomes and perioperative data.

Twenty-four studies (n = 1967 patients) were included in this review (n = 951, open-TLIF, n = 1016, MIS-TLIF). MIS-TLIF was associated with a significant decrease in the visual analog score (VAS)-back pain score (WMD = -0.44; P = 0.001), Oswestry Disabilities Index (WMD = -1.57; P = 0.005), early ambulation (WMD = -1.77; P = 0.0001), less blood loss (WMD = -265.59; P < 0.00001), and a shorter hospital stay (WMD = -1.89; P < 0.0001). However, there were no significant differences in the fusion rate (RR = 0.99; P = 0.34), VAS-leg pain (WMD = -0.10; P = 0.26), complication rate (RR = 0.84; P = 0.35), operation time (WMD = -5.23; P = 0.82), or reoperation rate (RR = 0.73; P = 0.32).

MIS-TLIF resulted in a similar fusion rate with better functional outcome, less blood loss, shorter ambulation, and hospital stay; furthermore, it did not increase the complication or reoperation rate based on the existing evidence.

Periprosthetic joint infection (PJI) is the main cause of failure following total joint arthroplasty. Until now, the diagnosis of PJI is still confronted with technical limitations, and the question of whether synovial fluid biomarker, C-reactive protein (CRP), can provide high value in the diagnosis of PJI remains unanswered and, therefore, was the aim of the study.

First, we conducted a systematic review on CRP in the diagnosis of PJI by searching online databases using keywords such as "periprosthetic joint infection", "synovial fluid", and "C-reactive protein". Eligible studies providing sufficient data to construct 2 × 2 contingency tables were then selected based on the list of criteria and the quality of included studies was assessed subsequently. Finally, the reported sensitivity, specificity, diagnostic odds ratio (DOR), summary receiver operating characteristic (SROC) curve, and the area under the SROC (AUSROC) were pooled together and used to evaluate overall diagnostic performance.

Seven studies were included in our review, six of which comprising a total of 456 participants were further investigated in our meta-analysis. The pooled sensitivity, specificity, and DOR were 0.92 (95% confidence interval [CI]: 0.86–0.96), 0.90 (95% CI: 0.87–0.93), and 101.40 (95% CI: 48.07–213.93), respectively. The AUSROC was 0.9663 (standard error, 0.0113).

Synovial fluid CRP is a good biomarker for the diagnosis of PJI with high sensitivity and specificity.

The objective of this study is to review cerebrospinal fluid leakage (CSFL) after thoracic decompression and describe its regular and special features.

Literature cited in this review was retrieved from PubMed and Medline and was primarily published during the last 10 years. "Cerebrospinal fluid", "leakage", "dural tears", and "thoracic decompression" were the indexed terms. Relevant citations in the retrieved articles were also screened to include more data.

All retrieved literature was scrutinized, and four categories were recorded: incidence and risk factors, complications, treatment modalities, and prognosis.

CSFL is much more frequent after thoracic decompression than after cervical and lumbar spinal surgeries. Its occurrence is related to many clinical factors, especially the presence of ossified ligaments and the adhesion of the dural sac. While its impact on the late neurological recovery is currently controversial, CSFL increases the risk of other perioperative complications, such as low intracranial pressure symptoms, infection, and vascular events. The combined use of primary repairs during the operation and conservative treatment postoperatively is generally effective for most CSFL cases, whereas lumbar drains and reoperations should be implemented as rescue options for refractory cases only.

CSFL after thoracic decompression has not been specifically investigated, so the present study provides a systematic and comprehensive review of the issue. CSFL is a multi-factor-related complication, and pathological factors play a decisive role. The importance of CSFL is in its impact on the increased risk of other complications during the postoperative period. Methods to prevent these complications are in need. In addition, though the required treatment resources are not special for CSFL after thoracic decompression, most CSFL cases are conservatively curable, and surgeons should be aware of it.

Glaucoma is a chronic progressive neurodegenerative disease and exhibits heterogeneity, polygenic inheritance, and incomplete penetrance.^[1]Primary open-angle glaucoma (POAG) is the most common form of glaucoma. Although the underlying etiology of POAG is unknown, there is evidence that genetic mutations are closely associated with this disease.^[2]Among myocilin (MYOC) mutations, Pro370Leu (P370L) is responsible for one of the most severe glaucoma phenotypes.^[3]However, the function of MYOC protein is still not well understood.

Cerebrospinal fluid (CSF) rhinorrhea is a common condition managed by neurosurgeons. The accurate identification of the site of leak plays a key role in facilitating successful surgical repair. We reported two surgery-proven cases of CSF rhinorrhea examined by magnetic resonance (MR) cisternography (Siemens, Berlin, Germany) and skull base coronal thin-section computed tomography (CT) scan (Siemens, Berlin, Germany) before surgical treatment. A 38-year-old man with primary complaints of "a sudden onset of headache and nausea and vomiting for 3 h" was admitted. He had a CSF rhinorrhea caused by head injury from a car accident 9 years ago, and his CSF leak resolved after conservative treatment. Since then, multiple recurrent episodes of CSF rhinorrhea and brain infection had developed. After admission, the patient had CSF rhinorrhea, grand mal seizures, hyperosmolarity, hyperglycemia, aspiration pneumonia, meningoencephalitis, and coma. After treatment, all symptoms disappeared except for CSF rhinorrhea. Skull base coronal thin-section CT scan showed a fracture in the left side of ethmoid plate, and MR cisternography revealed high-signal-intensity CSF column in the left side of the floor of anterior cranial fossa and sinus [Figure 1-case 1]. The patient was treated with "the surgical repair of CSF rhinorrhea via a left-sided subfrontal approach with a coronal incision" in December 2012, and a left ethmoid plate fracture or bony defect measuring 1.0 cm × 0.5 cm was identified and repaired. The patient’s CSF leak resolved after the surgery. He was managed with the lumbar drain for 1 week and had had no recurrence of CSF rhinorrhea at 3-month follow-up.

In treating superior laryngeal neuralgia (SLN), superior laryngeal nerve blocks (SLNBs) can provide immediate relief of persistent pain. Although SLNB was effective, the procedure can increase the risks due to the proximity to the carotid artery, external vein, and other vessels. To avoid complications such as advertent intravascular injection, local anesthetic toxicity from intravascular absorption, and intratracheal injection, we successfully blocked the superior laryngeal nerve under ultrasound guidance in three patients suffering from SLN. The written informed consent before treatment was obtained for each patient participating in this study.

To the Editor: A 35-year-old Chinese woman was admitted to our hospital complaining of a 1-year history of bilateral temporal chronic intermittent moderate headache which used to be alleviated by ibuprofen tablets or rest and had increased in intensity in the past 1 month. The patient also presented with the slow development of visual deficit. In January 2012, the patient presented with polyuria and polydipsia suggestive of central diabetes insipidus. Endocrine studies showed no clinically significant results. The patient also underwent a brain magnetic resonance imaging (MRI) which demonstrated an ovoid sellar lesion measuring 6 mm × 6 mm, with hyperintense, with no apparent enhancement after administration of gadolinium-diethylenetriaminepentaacetic acid (Gd-DTPA) on T1-weighted images and iso- to hypo-intense on T2-weighted images [Figure 1a]. The patient was initially diagnosed with Rathke’s cleft cyst (RCC) and refused to undergo the operation. By the end of 2013, she once again presented with polyuria and polydipsia that were in spontaneous remission in the following 6 months with no medical intervention. A radiographic follow-up was administrated in July 2014 demonstrating an ovoid sellar lesion measuring 9 mm × 11 mm × 14 mm indicative of enlargement of the former cyst, with hyperintense, with no obvious enhancement after administration of Gd-DTPA on T1-weighted images and iso- to hyper-intense on T2-weighted images [Figure 1b], and apparently, the signal characteristics of the MRI were almost the same as the initial one suggesting likely hemorrhage. From July 2014 to May 2015, she sought for medical services in the Department of Traditional Chinese Medicine and regularly took medicinal herbs aiming to promote circulation and remove stasis. In May 2015, she complained of a slightly blurred vision of her right eye. In November 2015, she was attacked by a severe unbearable headache, a vision’s sharp decline of the right eye, and mild right temporal hemianopsia. The pain was diffuse, dull, and persistent for a week and could not be alleviated by tablets or rest as before. Her medical history was otherwise unremarkable. The general physical examination was uneventful. The neurological examination showed an awake, alert, and completely oriented patient with no focal sign. The muscular strength and tension of her four limbs were completely normal. Various physiological reflexes could be elicited in response to external stimulus. Pathological signs were absent. The results of ophthalmologic tests were in accordance with her self-reported symptoms indicating remarkable changes of visual acuity (VA) and visual field. Preoperatively, VA of the right eye was 0.5+, and VA of the left eye was 0.8. Partial temporal hemianopia was observed with no suspect [Figure 1c]. The results of hematologic and biochemical tests were uneventful. Endocrine evaluations were within the normal ranges. MRI studies demonstrated a sellar and suprasellar lesion with hyperintense, with no apparent enhancement after administration of Gd-DTPA on T1-weighted images and hyperintense on T2-weighted images, measuring 16.8 mm × 16.0 mm × 14.6 mm [Figure 1d]. Located in the inferoposterior position of RCC, there was an irregular-shaped lesion showing hypointense on T1-weighted images and hypointense on T2-weighted images suggesting internal apoplexy. The mixed signal intensity was thought to be consistent with the symptom of apoplexy indicating intracystic old hemorrhage of RCC. Repeated MRI findings revealed the rapid enlargement of RCC within <4 years which was quite uncommon and likely to be described in published cases for the first time. The patient underwent an endoscopic endonasal transsphenoidal resection for RCC. In the procedure, the intracystic contents, which were seemingly yellowish cholesterol crystals instead of expected stale hemorrhage, were completely drained off, and the wall of RCC was resected as much as possible in a safe manner. Intracystic hemorrhage of RCC apoplexy was denied by surgical exploration. Intra- and post-operatively, leakage of cerebrospinal fluid and intracranial infection did not happen. The results of histopathological examinations proved the cystic lesion to be RCC. The patient recovered from the chronic headache; however, the visual deficits failed to improve significantly.

To the Editor: Obstructive sleep apnea syndrome (OSAS) is caused by recurrent episodes of complete or partial collapse of the upper airways during sleep and can induce apnea or hypopnea. Recurrent episodes of intermittent hypoxia and higher carbon dioxide levels may lead to frequent interruption of sleep.^[1]Nocturnal enuresis (NE) is characterized by the involuntary and recurrent voiding of urine during sleep. NE is a symptom of childhood OSAS, while it is rare in adults. Monosymptomatic NE (MNE) is defined as NE without daytime symptoms. We report an adult woman with MNE associated with severe OSAS whose symptoms completely disappeared after nasal continuous positive airway pressure (CPAP) therapy.

To the Editor: Zika virus (ZIKV) was first isolated from a rhesus monkey in the Zika forest in Uganda.^[1]It is an emerging arbovirus of theFlaviviridaefamily, which includes Dengue, West Nile, yellow fever, and Japanese encephalitis viruses, and causes a mosquito-borne disease transmitted by the Aedes genus.^[2]ZIKV was demonstrated explosion recently in American countries, especially in Brazil, Venezuela, and so on.^[3]We reported a case of laboratory-confirmed ZIKV infection imported into China from Venezuela. The patient developed fever, rash, myalgia, headache, and conjunctivitis after returning to China from Venezuela on February 6, 2016. Serological investigations revealed positive ZIKV-specific real-time reverse transcription-polymerase chain reaction (RT-PCR).

To the Editor: Pediatric inguinal hernia repair is a common surgical procedure performed in pediatric patients. Laparoscopic herniorrhaphy has several advantages over conventional open herniotomy; most of them related to the evaluation of possible contralateral patent processus vaginalis (PPV) and avoidance of trauma to the vas deferens and spermatic vessels.

In the article, "Preparation and characterization of paclitaxel- loaded poly lactic acid-co-glycolic acid coating tracheal stent," which appeared in the pages 2236-40, issue 12, vol. 127 ofChinese Medical Journal,^[1]the "Financial support and sponsorship" section of the article was incorrectly written as "the Capital Clinical Application Research (No. Z121107001012128)" instead of "Beijing Municipal Administration of Hospitals Clinical Medicine Development of Special Funding Support (No. XMLX201314)."