2016年 · 第129卷第17期

Chronic obstructive pulmonary disease (COPD) is a heterogeneous disease with high morbidity and mortality.^[1]With increasing use of computed tomography in the assessment of patients with COPD, the presence of previously unrecognized radiological bronchiectasis is being identified.^[2]Accumulating evidence shows that bronchiectasis has an important impact on the natural history of COPD. Moderate-severe COPD with comorbid bronchiectasis has more severe symptoms, higher frequency of exacerbations, and increased mortality.^[3]Given the prognostic implications of bronchiectasis in COPD, its detection could serve as a guide to better management and eventually improved survival.^[1]Therefore, bronchiectasis was proposed as a comorbidity of COPD by Global Initiative for Chronic Obstructive Lung Disease (GOLD) updated 2014. The prevalence of bronchiectasis in COPD is highly varied, mostly due to patient inclusion criteria such as different GOLD stages, and different definitions of bronchiectasis. Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints revealed a prevalence of bronchiectasis in 4% of COPD patients with all GOLD stages,^[4]but much higher prevalence of bronchiectasis in COPD patients was reported, ranging from 20% to 58% in both primary and secondary care.^[2,5,6]In a study from Spain, bronchiectasis was found in 57.6% of patients with moderate to severe COPD,^[7]while in a Turkish study the prevalence was 33%.^[8]A recent study from the UK showed that 69% of COPD patients with acute exacerbation had some evidence of bronchiectasis, mostly minor or mild in severity; minor 40%, mild 29%, moderate 22%, and severe 8%.^[9]A nationwide diagnosis-related groups hospital statistics for the years 2005–2011 in Germany indicated that COPD was found in up to 39.2% of hospitalizations with bronchiectasis as the primary diagnosis.^[10]Recent studies in Chinese patients showed that 34.7% (311/896)^[11]and 45.8% (87/190)^[12]of stable COPD patients were coexistent with bronchiectasis revealed by lung high-resolution computed tomography (HRCT).

Although radiological features of pneumocystis pneumonia (PCP) in non-Acquired Immune Deficiency Syndrome (AIDS) immunocompromised patients have been reported by other authors, there were no studies on the radiological stages of PCP previously. This study aimed to elucidate the radiological stages and prognoses of PCP in non-AIDS immunocompromised patients.

Retrospective analysis of radiological manifestations and prognoses of 105 non-AIDS PCP immunocompromised patients from August 2009 to April 2016 was conducted. Chest radiograph was divided into three stages: early stage (normal or nearly normal chest radiograph), mid stage (bilateral pulmonary infiltrates), and late stage (bilateral pulmonary consolidations); chest high-resolution computed tomography (HRCT) was also divided into three stages: early stage (bilateral diffuse ground-glass opacity [GGO]), mid stage (bilateral diffuse GGO and patchy consolidations), and late stage (bilateral diffuse consolidations).

The case fatality rate (CFR) of all patients was 34.3% (36/105), all of them took routine chest X-ray (CXR), and 84 underwent chest CT examinations. According to the CXR most near the beginning of anti-PCP therapy, 18 cases were at early stage and CFR was 0 (0/18, P < 0.01), 50 cases were at mid stage and CFR was 28.0% (14/50, P> 0.05), and 37 cases were at late stage and CFR was 59.5% (22/37, P < 0.01). According to the chest HRCT most near the beginning of anti-PCP therapy, 40 cases were at early stage and CFR was 20.0% (8/40, P > 0.05), 34 cases were at mid stage and CFR was 47.1% (16/34, P > 0.05), and 10 cases were at late stage and CFR was 80.0% (8/10, P < 0.05); barotrauma, including pneumothorax, pneumomediastinum, and pneumohypoderma, was found in 18 cases and the CFR was 77.8% (14/18, P < 0.01).

Based on the radiological manifestations, the course of PCP in non-AIDS immunocompromised patients can be divided into three stages: early stage, mid stage, and late stage. The prognoses of patients treated at early stage are good, and those at late stage are poor. Furthermore, the CFR of patients with barotrauma is high.

Increased level of serum macrophage inhibitory cytokine-1 (MIC-1), a member of transforming growth factor-β superfamily, was found in patients with epithelial tumors. This study aimed to evaluate whether serum level of MIC-1 can be a candidate diagnostic and prognostic indicator for early-stage nonsmall cell lung cancer (NSCLC).

A prospective study enrolled 152 patients with Stage I–II NSCLC, who were followed up after surgical resection. Forty-eight patients with benign pulmonary disease (BPD) and 105 healthy controls were also included in the study. Serum MIC-1 levels were measured using an enzyme-linked immunosorbent assay, and the association with clinical and prognostic features was analyzed.

In patients with NSCLC, serum protein levels of MIC-1 were significantly increased compared with healthy controls and BPD patients (all P < 0.001). A threshold of 1000 pg/ml of MIC-1 was found in patients with early-stage (Stage I and II) NSCLC, with sensitivity and specificity of 70.4% and 99.0%, respectively. The serum levels of MIC-1 were associated with age (P = 0.001), gender (P = 0.030), and T stage (P = 0.022). Serum MIC-1 threshold of 1465 pg/ml was found in patients with poor early outcome, with sensitivity and specificity of 72.2% and 66.1%, respectively. The overall 3-year survival rate of NSCLC patients with high serum levels of MIC-1 (≥1465 pg/ml) was lower than that of NSCLC patients with low serum MIC-1 levels (77.6% vs. 94.8%). Multivariate Cox regression survival analysis showed that a high serum level of MIC-1 was an independent risk factor for reduced overall survival (hazard ratio = 3.37, 95% confidential interval: 1.09–10.42, P = 0.035).

The present study suggested that serum MIC-1 may be a potential diagnostic and prognostic biomarker for patients with early-stage NSCLC.

Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae bacteria, which cause serious disease outbreaks worldwide, was rarely detected in Xiangya Hospital, prior to an outbreak that occurred from August 4, 2014, to March 17, 2015. The aim of this study was to analyze the epidemiology and molecular characteristics of the K. pneumoniae strains isolated during the outbreak.

Nonduplicate carbapenem-resistant K. pneumoniae isolates were screened for bla_KPC-2 and multiple other resistance determinants using polymerase chain reaction. Subsequent studies included pulsed-field gel electrophoresis (PFGE), multilocus sequence typing, analysis of plasmids, and genetic organization of bla_KPC-2 locus.

Seventeen bla_KPC-2-positive K. pneumoniae were identified. A wide range of resistant determinants was detected. Most isolates (88.2%) coharbored bla_KPC-2 and rmtB in addition to other resistance genes, including bla_SHV-1, bla_TEM-1, and aac(3)-IIa. The bla_KPC-2 and rmtB genes were located on the conjugative IncFIB-type plasmid. Genetic organization of bla_KPC-2 locus in most strains was consistent with that of the plasmid pKP048. Four types (A1, A2, A3, and B) were detected by PFGE, and Type A1, an ST11, was the predominant PFGE type. A novel K. pneumoniae sequence type (ST1883) related to ST11 was discovered.

These isolates in our study appeared to be clonal and ST11 K. pneumoniae was the predominant clone attributed to the outbreak. Coharbing of bla_KPC-2 and rmtB, which were located on a transferable plasmid, in clinical K. pneumoniae isolates may lead to the emergence of a new pattern of drug resistance.

Bronchiolitis obliterans syndrome (BOS) often develops in transplant patients and results in injury to the respiratory and terminal airway epithelium. Owing to its rising incidence, the pathogenesis of BOS is currently an area of intensive research. Studies have shown that injury to the respiratory epithelium results in dysregulation of epithelial repair. Airway epithelial regeneration is supported by stromal cells, including fibroblasts. This study aimed to investigate whether the supportive role of lung fibroblasts is altered in BOS.

Suspensions of lung cells were prepared by enzyme digestion. Lung progenitor cells (LPCs) were separated by fluorescence-activated cell sorting. Lung fibroblasts from patients with BOS or healthy controls were mixed with sorted mouse LPCs to compare the colony-forming efficiency of LPCs by counting the number of colonies with a diameter of ≥50 μm in each culture. Statistical analyses were performed using the SPSS 17.0 software (SPSS Inc., USA). The paired Student’s t-test was used to test for statistical significance.

LPCs were isolated with the surface phenotype of CD31^-CD34^-CD45^- EpCAM⁺Sca-1⁺. The colony-forming efficiency of LPCs was significantly reduced when co-cultured with fibroblasts isolated from patients with BOS. The addition of SB431542 increased the colony-forming efficiency of LPCs to 1.8%; however, it was still significantly less than that in co-culture with healthy control fibroblasts (P < 0.05).

The epithelial-supportive capacity of fibroblasts is impaired in the development of BOS and suggest that inefficient repair of airway epithelium could contribute to persistent airway inflammation in BOS.

There is an unmet need for a reliable method of airway management for patients in the lateral position. This prospective randomized controlled two-center study was designed to evaluate the feasibility of intubation using a flexible fiberoptic bronchoscope in the lateral position during surgery.

Seventy-two patients scheduled for elective nonobstetric surgery in the lateral decubitus position requiring tracheal intubation under general anesthesia at Lishui Central Hospital of Zhejiang Province and Jiaxing First Hospital of Zhejiang Province from April 1, 2015, to September 30, 2015, were enrolled in this study. Patients were randomly assigned to the supine position group (Group S, n = 38) and the lateral position group (Group L, n = 34). Experienced anesthetists performed tracheal intubation with a fiberoptic bronchoscope after general anesthesia. The time required for intubation, intubation success rates, and hemodynamic changes was recorded. Between-group differences were assessed using the Student’s t-test, Mann–Whitney U-test, or Chi-square test.

The median total time to tracheal intubation was significantly longer in Group S (140.0 [135.8, 150.0] s) compared to Group L (33.0 [24.0, 38.8] s) (P < 0.01). The first-attempt intubation success rate was significantly higher in Group L (97%) compared to Group S (16%). Hemodynamic changes immediately after intubation were more exaggerated in Group S compared to Group L (P = 0.02).

Endotracheal intubation with a flexible fiberoptic bronchoscope may be an effective and timesaving technique for patients in the lateral position.

Chinese Clinical Trial Register, ChiCTR-IIR-16007814; http://www.chictr.org.cn/showproj .aspx?proj=13183.

Urine output (UO) is an essential criterion of the Kidney Disease Improving Global Outcomes (KDIGO) definition and classification system for acute kidney injury (AKI), of which the diagnostic value has not been extensively studied. We aimed to determine whether AKI based on KDIGO UO criteria (KDIGO_UO) could improve the diagnostic and prognostic accuracy, compared with KDIGO serum creatinine criteria (KDIGO_SCr).

We conducted a secondary analysis of the database of a previous study conducted by China Critical Care Clinical Trial Group (CCCCTG), which was a 2-month prospective cohort study (July 1, 2009 to August 31, 2009) involving 3063 patients in 22 tertiary Intensive Care Units in Mainland of China. AKI was diagnosed and classified separately based on KDIGO_UO and KDIGO_SCr. Hospital mortality of patients with more severe AKI classification based on KDIGO_UO was compared with other patients by univariate and multivariate regression analyses.

The prevalence of AKI increased from 52.4% based on KDIGO_SCr to 55.4% based on KDIGO_SCr combined with KDIGO_UO. KDIGO_UO also resulted in an upgrade of AKI classification in 7.3% of patients, representing those with more severe AKI classification based on KDIGO_UO. Compared with non-AKI patients or those with maximum AKI classification by KDIGO_SCr, those with maximum AKI classification by KDIGO_UO had a significantly higher hospital mortality of 58.4% (odds ratio [OR]: 7.580, 95% confidence interval [CI]: 4.141–13.873, P < 0.001). In a multivariate logistic regression analysis, AKI based on KDIGO_UO (OR: 2.891, 95% CI: 1.964–4.254, P < 0.001), but not based on KDIGO_SCr (OR: 1.322, 95% CI: 0.902–1.939, P = 0.152), was an independent risk factor for hospital mortality.

UO was a criterion with additional value beyond creatinine criterion for AKI diagnosis and classification, which can help identify a group of patients with high risk of death.

The primary cause of ischemic heart failure (HF) is myocardial infarction (MI) resulting in left ventricle (LV) wall motion abnormality secondary to ventricular remodeling. A prospective, nonrandomized study conducted in China was designed to assess safety and efficacy of the percutaneous ventricular restoration therapy using Parachute device (CardioKinetix, Inc., CA, USA) in ischemic HF patients as a result of LV remodeling after anterior wall MI.

Thirty-one patients with New York Heart Association (NYHA) Class II, III ischemic HF, ejection fraction between 15% and 40%, and dilated akinetic or dyskinetic anterior-apical wall without the need to be revascularized were enrolled from seven sites in China from October to December 2014. The Parachute device was implanted through femoral artery. All patients received low-dose aspirin and anticoagulation with warfarin for at least 12 months postdevice implantation. The primary end-point was the assessment of efficacy as measured by the reduction in LV end-systolic volume index (LVESVI) against baseline LVESVI at 3 months postdevice implantation, determined by the echocardiography and measured by echocardiography core laboratory. Quality of life was assessed using EQ-5D and visual analog scale (VAS). For quantitative data comparison, paired t-test (normality data) and signed-rank test (abnormality data) were used; application of signed-rank test was for the ranked data comparison.

A change in LVESVI as measured by echocardiography from the preimplant baseline to 3-month postdevice implantation revealed a statistically significant reduction from 77.5 ± 20.0 ml/m² to 53.1 ± 17.0 ml/m² (P < 0.0001). The trial met its primary end-point. Of the 31 patients, the procedural success was 96.8%. Overall, NYHA HF class assessment results showed an improvement of more than half a class at 3 months (P < 0.001). Quality of life assessed by the VAS value increased 11.5 points (P < 0.01), demonstrating improvement at 3 months.

The favorable outcomes observed in the high-risk patients provide reassuring safety and efficacy data to support adoption of this technology as a therapeutic option for ischemic HF patients.

ClinicalTrials.gov, NCT02240940; https://clinicaltrials.gov/ct2/show/NCT02240940.

Spontaneous potentials in electromyography (EMG) of paraspinal muscles are associated with diaphragm denervation and, therefore, poor respiratory function in amyotrophic lateral sclerosis (ALS) is understandable. EMG changes in the rectus abdominis (RA) display an effect similar to those in paraspinal muscles with respect to the function of lower motor neurons in the thoracic spinal cord. The RA denervation was examined to determine its association with ventilation dysfunction in ALS.

We collected the clinical data of 128 patients with sporadic ALS in Department of Neurology of Peking University Third Hospital from 2009 to 2013. EMG, Revised ALS Functional Rating Scale (ALSFRS-R) and forced vital capacity (FVC) were performed in all patients and the differences in the EMG changes in RA between those with and without FVC ≥ 80% were analysed.

The mean FVC value was 83.4% ± 17.1% (range: 45%–131%) of the predicted value. A total of 79 patients displayed FVC ≥80%, and 49 patients displayed FVC <80%. Compared with the patients displaying a normal FVC (60/79, 75.9%), spontaneous activity in RA was significantly different among those patients displaying an FVC <80% (47/49, 95.9%). In addition, spontaneous potentials in RA were more frequently detected in patients exhibiting dyspnea (32/33, 97.0%) than in patients without dyspnea (75/95, 78.9%).

Spontaneous potentials in RA are associated with ventilation dysfunction and dyspnea in ALS patients.

Percutaneous nephrolithotomy (PCNL) is the most widely recommended treatment for calyceal diverticular calculi, providing excellent stone-free results. However, its invasiveness is not negligible considering its major complication rates. Flexible ureteroscopy (FURS) is currently used to treat calyceal diverticula. However, the greatest drawback of FURS is locating the diverticulum since its neck is narrow and concealed. In such a case, the FURS procedure must be converted to PCNL. The aim of this study was to evaluate ultrasound-guided flexible ureteroscopy (UFURS) identifying diverticulum and the management of calyceal diverticular calculi.

A retrospective analysis was conducted on 24 patients who had calyceal diverticular calculi. In all 12 patients in the UFURS group, direct FURS failed to find evidence of calyceal diverticula but were confirmed with imaging. The other 12 patients in the PCNL group received PCNL plus fulguration of the diverticular walls.

Puncture of calyceal diverticulum was successful in all 12 UFURS patients. Two patients in this group had postoperative residual calculi and two patients developed fever. In the PCNL group, percutaneous renal access and lithotomy were successful in all 12 patients. One patient in this group had residual calculi, one had perirenal hematoma, and two patients developed fever. No significant difference was found in the operating time (UFURS vs. PCNL, 91.8 ± 24.2 vs. 86.3 ± 18.7 min), stone-free rate (UFURS vs. PCNL, 9/12 vs. 10/12), and rate of successful lithotripsy (UFURS vs. PCNL, 10/12 vs. 11/12) between the two groups (all P > 0.05). Postoperative pain scores in the FURS group were significantly lower than that in the PCNL group (2.7 ± 1.2 vs. 6.2 ± 1.5, P < 0.05). Hospital stay in the UFURS group was significantly shorter than that in the PCNL group (3.4 ± 0.8 vs. 5.4 ± 1.0 days, P < 0.05). All patients were symptom-free following surgery (UFURS vs. PCNL, 10/10 vs. 12/12).

Ultrasound-guided puncture facilitates identification of calyceal diverticula during FURS and improves the success rate of FURS surgery.

Previous studies revealed that culprit vessels of ST-segment elevation myocardial infarction (STEMI) were often related to mild or moderate stenosis. However, recent studies suggested that severe stenosis was primarily found in culprit lesions. The objective of this study was to analyze the stenosis severity of culprit lesions in STEMI patients and to clarify the paradoxical results.

A total of 489 consecutive STEMI patients who underwent primary percutaneous coronary intervention were retrospectively studied from January 2012 to December 2014. The patients were divided into three groups based on stenosis severity using quantitative coronary analysis: Group A, 314 cases, stenosis ≥70%; Group B, 127 cases, stenosis 50–70%; and Group C, 48 cases, stenosis ≤50%. The clinical, demographic, and angiographic data of all groups were analyzed.

Patients in Group A exhibited a significantly higher prevalence of history of angina pectoris (95.9% vs. 62.5%, P < 0.001), multivessel disease (73.2% vs. 54.2%, P = 0.007), and lower cardiac ejection fraction (53.3 ± 8.6 vs. 56.8 ± 8.4, P = 0.009) than those in Group C. Multivariable analysis revealed that history of angina pectoris (odds ratio [OR]: 13.89, 95% confidence interval [CI]: 6.21–31.11) and multivessel disease (OR: 2.32, 95% CI: 1.25–4.31) were correlated with severe stenosis of the culprit lesion in Group A.

Most culprit lesions in STEMI patients were severe stenosis. These patients exhibited a higher prevalence of angina history and multivessel diseases.

High-quality information provision can allow stroke patients to effectively participate in healthcare decision-making, better manage the stroke, and make a good recovery. In this study, we reviewed information needs of stroke patients, methods for providing information to patients, and considerations needed by the information providers.

The literature concerning or including information provision for patients with stroke in English was collected from PubMed published from 1990 to 2015.

We included all the relevant articles on information provision for stroke patients in English, with no limitation of study design.

Stroke is a major public health concern worldwide. High-quality and effective health information provision plays an essential role in helping patients to actively take part in decision-making and healthcare, and empowering them to effectively self-manage their long-standing chronic conditions. Different methods for providing information to patients have their relative merits and suitability, and as a result, the effective strategies taken by health professionals may include providing high-quality information, meeting patients’ individual needs, using suitable methods in providing information, and maintaining active involvement of patients.

It is suggested that to enable stroke patients to access high-quality health information, greater efforts need to be made to ensure patients to receive accurate and current evidence-based information which meets their individual needs. Health professionals should use suitable information delivery methods, and actively involve stroke patients in information provision.

The prognosis of patients who suffer from coma after cardiopulmonary resuscitation (CPR) may be poor (defined as cerebral performance categories scores from 3 to 5).^[1,2]Thus, an accurate prediction of their neurological outcomes is an essential component of post-cardiac arrest evaluation, especially for decisions to limit or withdraw life-sustaining care. Since the 1960s, a series of domestic and foreign studies began to focus on the evaluation of coma patients after CPR, and considerable progress has been achieved in this field.

At the end of March 2013, the first case of human infection with avian influenza A(H7N9) virus was confirmed in Shanghai. From April to May 2013, 18 patients with avian influenza A(H7N9) virus infection were hospitalized in Shanghai Public Health Clinical Center, and finally, 12 of them survived. The short-term prognosis of these patients had been described previously,^[1]but the long-term prognosis remained unclear. From September to November 2013, 5 survivors with avian influenza A(H7N9) virus infection discharged from Shanghai Public Health Clinical Center were admitted to Zhongshan Hospital, Fudan University. Data of demographic characteristics, diagnosis, and underlying comorbidities were obtained from the patients. Then, the patients had undergone thoracic high-resolution computed tomography (HRCT) and pulmonary function tests (PFT). The HRCT was evaluated by a radiologist and a pulmonologist independently and then reached consensus. The presence and distribution of the following radiologic abnormalities, namely, consolidations, ground-glass opacities (GGOs), air bronchograms, centrilobular nodules, interlobular septal thickening, reticulations, subpleural linear opacities, cystic changes, and pleural effusion, were assessed for each patient. The following indices of PFT, namely, forced vital capacity (FVC), forced expiratory volume in 1 s (FEV₁), FEV₁/FVC, total lung capacity (TLC), and the diffusion capacity for carbon monoxide of lung (DLCO), were assessed and expressed as percentages of values predicted. Bronchial provocation and dilation test were not included in the protocol. This study was approved by the Institutional Review Board of Zhongshan Hospital, Fudan University.

Relative to the length and surface area of the gastrointestinal tract, malignant tumors of the small intestine are remarkably rare, with a global incidence of <1 per 100,000 population.^[1]Among the forty different histological subtypes of small intestinal cancers, primary squamous cell carcinoma (SCC) is exceptionally rare with only occasional case reports in literature. The present study reported a case of primary SCC of the small intestine and reviewed all cases reported in English literature to provide a systematic overview of this rare disease.

Symmastia is defined as the medial confluence of both breasts or unification of the breasts by soft tissue on the sternum rendering them inseparable. It was first described in the plastic surgery literature by Spenceet al. in 1984.^[1,2,3]Two forms of symmastia exist; acquired and congenital.^[1,2,3]Acquired symmastia is a very common condition that results as an iatrogenic complication of over-dissecting a pocket, or using implants with a diameter that is too large in proportion to the chest wall during breast augmentation or reconstruction.^[2,3]Whereas, congenital symmastia is an extremely rare condition caused by a developmentally aberrant proliferation of mammary tissue, resulting in an intermammary web crossing the sternal midline.^[2,3]This web-like soft tissue is composed of glandular tissue, subcutaneous fat, and fibrous septa in different proportions, which traverses the sternum to connect both breasts medially.^[1,2,4,5]Only a few case reports of congenital symmastia have been previously reported, and the knowledge of its pathophysiology, exact incidence, and ideal treatment is still insufficient.^[2,3]Herein, we present a case of congenital symmastia with macromastia corrected with liposuction and reduction mammoplasty with good esthetic results. To the best of our knowledge, there has been only one case reported in Asia,^[5]and the current case report is rare in Korea.

To the Editor: A 65-year-old female patient presented with the complaints of hemoptysis and the left upper chest pain for about 1 week. The medical history revealed coronary heart disease and paroxysmal atrial fibrillation, smoking for about 40 years, no drinking, and no special contact history. There was a prior history of chronic cough without dyspnea or hemoptysis for about 20 years. Physical examination revealed a well-developed, well-nourished female in no apparent distress. The patient was afebrile with a heart rate of 78 beats/min, blood pressure of 130/70 mmHg, respiratory rate of 18 breaths/min, and oxygen saturation of 100% at room air. There was no peripheral lymphadenopathy. Chest auscultation was slightly diminished, breath sounds were heard at the left upper lung, and neither wet nor dry rale was heard in both lungs.

To the Editor: The efficacy of minimally invasive techniques for pulmonary lobectomy is gaining a great interest in literature. Recently, new surgical strategies and technical improvements have been reported for video-assisted thoracic surgery (VATS).^[1]Furthermore, postoperative physiotherapeutic aspects are a source of interest; it has been observed that the walking distance, calculated as the mean score on the 6-min walk test (6MWT) preoperatively, represents a predictive measure for the onset of possible postoperative complications following pulmonary lobectomy.^[2]Nevertheless, the suitability of the 6MWT during the early postoperative period is limited by common functional limitations that are normally present after surgery, including the possible need for oxygen supplementation during the first days postoperatively and the presence of thoracic drainage.

To the Editor:Schizophyllum communeis a ubiquitous basidiomycetous fungus that commonly colonizes rotting wood.^[1]Reports of pulmonary involvement due toS. communeare limited. We herein reported a case of pulmonary mycosis due toS. communein the First Affiliated Hospital of College of Medicine, Zhejiang University.

In the article titled, "The Survey of Birth Defects Rate on Birth Registration System" published in pages 7-14, issue 1, vol. 128 of Chinese Medical Journal,^[1]the following sentences have "‰" sign written incorrectly as "%" sign: