2018年 · 第131卷第04期

Obesity induces dyslipidemia, hypertension, glucose intolerance, and inflammatory state, which results in atherogenic processes, diabetes, and cardiovascular disease. We usually use body composition indices, such as body mass index (BMI), body fat percentage (BFP), waist circumference-height ratio (WHtR), and waist-hip ratio (WHR) to reflect the obesity. The aim of this large population-based cross-sectional study was to investigate the associations between body composition indices and metabolic parameters in Chinese adults.

A total of 12,018 Chinese adults were included. Body composition indices, such as BMI, BFP, WHtR, and WHR, and metabolic parameters, such as systolic blood pressure (SBP), diastolic blood pressure (DBP), total cholesterol (TC), triglyceride (TG), low-density lipoprotein-cholesterol (LDL-C), high-density lipoprotein-cholesterol (HDL-C), fasting blood glucose (FBG), 2 h postprandial blood glucose (2h PBG), glycosylated hemoglobin (HbA1c), fasting insulin (FINS), insulin resistance index (HOMA-IR), high-sensitivity C-reactive protein (hs-CRP), and white blood cell count (WBC), were measured and analyzed. All analyses were stratified by gender.

All body composition indices and metabolic parameters except 2h PBG differed significantly between males and females (all P < 0.001). BMI was positively associated with SBP, DBP, LDL-C, TC, TG, FBG, 2h PBG, HbA1c, FINS, HOMA-IR, hs-CRP, and WBC, and inversely associated with HDL-C; similar relationships were identified between the metabolic parameters and BFP, WHtR, and WHR. In the multivariate analysis, the odds of impaired glucose regulation, dyslipidemia, insulin resistance, and increased hs-CRP were 1.36, 1.92, 3.44, and 1.27 times greater in the overweight group than those in the normal weight group, respectively, and 1.66, 3.26, 7.53, and 1.70 times greater in the obese group than those in the normal weight group, respectively. The odds of dyslipidemia and hs-CRP were 1.29 and 1.38 times greater in the BFP ≥28.0% group than in the BFP <28.0% group, respectively. The odds of dyslipidemia, HOMA-IR, and hs-CRP were 1.55, 1.26, and 1.48 times greater in the WHtR ≥0.96 group than in the WHtR <0.96 group, respectively. Among males, the odds of HOMA-IR were 1.46 times greater in the WHR ≥0.54 group than in the WHR <0.54 group. Similar results were observed in females.

This study identified positive associations between all evaluated body composition indices and metabolic parameters in Chinese adults. Among the body composition indices, BMI predicted four of the five evaluated metabolic disorders in both gender groups.

Cervical cancer shows a growing incidence and medical cost in recent years that has increased severe financial pressure on patients and medical insurance institutions. This study aimed to investigate the medical economic characteristics of cervical cancer patients with different payment modes within a Grade A tertiary hospital to provide evidence and suggestions for inpatient cost control and to verify the application of Gamma model in medical cost analysis.

The basic and cost information of cervical cancer cases within a Grade A tertiary hospital in the year 2011–2016 were collected. The Gamma model was adopted to analyze the differences in each cost item between medical insured patient and uninsured patients. Meanwhile, the marginal means of different cost items were calculated to estimate the influence of payment modes toward different medical cost items among cervical cancer patients in the study.

A total of 1321 inpatients with cervical cancer between the 2011 and 2016 were collected through the medical records system. Of the 1321 cases, 65.9% accounted for medical insured patients and 34.1% were uninsured patients. The total inpatient medical expenditure of insured patients was RMB 29,509.1 Yuan and uninsured patients was RMB 22,114.3 Yuan, respectively. Payment modes, therapeutic options as well as the recurrence and metastasis of tumor toward the inpatient medical expenditures between the two groups were statistically significant. To the specifics, drug costs accounted for 37.7% and 33.8% of the total, surgery costs accounted for 21.5% and 25.5%, treatment costs accounted for 18.7% and 16.4%, whereas the costs of imaging and laboratory examinations accounted for 16.4% and 15.2% for the insured patient and uninsured patients, respectively. As the effects of covariates were controlled, the total hospitalization costs, drug costs, treatment costs as well as imaging and laboratory examination costs showed statistical significance. The total hospitalization costs, drug costs, treatment costs as well as imaging and laboratory examination costs of insured patient were 1.33, 1.42, 1.52, and 1.44 times of uninsured patients.

The analysis of different payment modes toward the medical economic characteristics based on Gamma model is basically rational. Medical payment modes are having certain influence toward the hospitalization expenses of cervical cancer patients in an extent, as drug costs, treatment costs, and examination costs appear to be the main causes.

The first and most important step in characterizing familial nonmedullary thyroid carcinoma (NMTC) is to distinguish the true familial patients, which is the prerequisite for all accurate analyses. This study aimed to investigate whether patients from families with ≥3 first-degree relatives affected with NMTC have different characteristics than patients from families with only two affected members, and to compare these patients with those with sporadic disease.

We analyzed the clinicopathological features and prognosis of 209 familial and 1120 sporadic cases of NMTC. Familial patients were further divided into two subgroups: families with two affected members and families with ≥3 affected members.

The familial group had a significantly higher risk of bilateral growth, multifocality, extrathyroidal extension, and lateral lymph node metastasis than the sporadic group (P < 0.05). These main features were also different between the group with ≥3 affected members and the sporadic group. The only difference between the two affected members’ group and the sporadic group was incidence of multifocality (P < 0.05). The probability of disease recurrence in patients from families with ≥3 affected members was significantly higher than that in sporadic cases (14.46% vs. 5.27%; P = 0.001), while the probability in patients from families with two affected members was similar to that in sporadic patients (6.35% vs. 5.27%; P = 0.610). The Kaplan–Meier survival analysis showed a statistically significant difference in disease-free survival between the two subgroups (85.54% vs. 93.65%; P = 0.045).

Patients from families with ≥3 members affected by NMTC have more aggressive features and a worse prognosis than those from families with only two affected members. Patients from families with ≥3 affected first-degree relatives may be considered to have true familial NMTC.

The worsening of semen quality, due to the application of Wi-Fi, can be ameliorated by Vitamin E. This study aimed to demonstrate whether a moderate dose of trolox, a new Vitamin E, inhibits oxidative damage on sperms in vitro after exposure to Wi-Fi radiation.

Each of the twenty qualified semen, gathered from June to October 2014 in eugenics clinic, was separated into four aliquots, including sham, Wi-Fi-exposed, Wi-Fi plus 5 mmol/L trolox, and Wi-Fi plus 10 mmol/L trolox groups. At 0 min, all baseline parameters of the 20 samples were measured in sequence. Reactive oxygen species, glutathione, and superoxide dismutase were evaluated in the four aliquots at 45 and 90 min, as were sperm DNA fragments, sperm mitochondrial potential, relative amplification of sperm mitochondrial DNA, sperm vitality, and progressive and immotility sperm. The parameters were analyzed by one-way analysis of variance and Tukey’s posttest.

Among Wi-Fi plus 5 mmol/L trolox, Wi-Fi-exposed and Wi-Fi plus 10 mmol/L trolox groups, reactive oxygen species levels (45 min: 3.80 ± 0.41 RLU·10⁻⁶·ml⁻¹ vs. 7.50 ± 0.35 RLU·10⁻⁶·ml⁻¹ vs. 6.70 ± 0.47 RLU·10⁻⁶·ml⁻¹, P < 0.001; 90 min: 5.40 ± 0.21 RLU·10⁻⁶·ml⁻¹ vs. 10.10 ± 0.31 RLU·10⁻⁶·ml⁻¹ vs. 7.00 ± 0.42 RLU·10⁻⁶·ml⁻¹, P < 0.001, respectively), percentages of tail DNA (45 min: 16.8 ± 2.0% vs. 31.9 ± 2.5% vs. 61.3 ± 1.6%, P < 0.001; 90 min: 19.7 ± 1.5% vs. 73.7 ± 1.3% vs. 73.1 ± 1.1%, P < 0.001, respectively), 8-hydroxy-2’-deoxyguanosine (45 min: 51.89 ± 1.46 pg/ml vs. 104.89 ± 2.19 pg/ml vs. 106.11 ± 1.81 pg/ml, P = 0.012; 90 min: 79.96 ± 1.73 pg/ml vs. 141.73 ± 2.90 pg/ml vs. 139.06 ± 2.79 pg/ml; P < 0.001), and percentages of immotility sperm (45 min: 27.7 ± 2.7% vs. 41.7 ± 2.2% vs. 41.7 ± 2.5%; 90 min: 29.9 ± 3.3% vs. 58.9 ± 4.0% vs. 63.1 ± 4.0%; all P < 0.001) were lowest, and glutathione peroxidase (45 min: 60.50 ± 1.54 U/ml vs. 37.09 ± 1.77 U/ml vs. 28.18 ± 1.06 U/ml; 90 min: 44.61 ± 1.23 U/ml vs. 16.86 ± 0.93 U/ml vs. 29.94 ± 1.56 U/ml; all P < 0.001), percentages of head DNA (45 min: 83.2 ± 2.0% vs. 68.2 ± 2.5% vs. 38.8 ± 1.6%; 90 min: 80.3 ± 1.5% vs. 26.3 ± 1.3% vs. 26.9 ± 1.1%; all P < 0.001), percentages of sperm vitality (45 min: 89.5 ± 1.6% vs. 70.7 ± 3.1% vs. 57.7 ± 2.4%; 90 min: 80.8 ± 2.2% vs. 40.4 ± 4.0% vs. 34.7 ± 3.9%; all P < 0.001), and progressive sperm (45 min: 69.3 ± 2.7% vs. 55.8 ± 2.2% vs. 55.4 ± 2.5%; 90 min: 67.2 ± 3.3% vs. 38.2 ± 4.0% vs. 33.9 ± 4.0%; all P < 0.001) were highest in Wi-Fi plus 5 mmol/L trolox group at 45 and 90 min, respectively. Other parameters were not affected, while the sham group maintained the baseline.

This study found that 5 mmol/L trolox protected the Wi-Fi-exposed semen in vitro from the damage of electromagnetic radiation-induced oxidative stress.

Most studies on enhanced recovery after surgery (ERAS) for gastric cancer exclude patients who received neoadjuvant chemotherapy. Here, we aimed to evaluate whether patients who received neoadjuvant chemotherapy can be enrolled into the ERAS program for locally advanced gastric cancer.

From April 2015 to July 2017, 114 patients who received neoadjuvant chemotherapy for locally advanced gastric cancer were randomized into ERAS and standard care (SC) groups. Postoperative length of stay, complications, bowel function, and nutritional status were recorded.

The postoperative length of stay of the ERAS group was shorter compared with that of the SC group (5.9 ± 5.6 vs. 8.1 ± 5.3 days, P = 0.037). The postoperative complication rate was 9.3% in the ERAS group and 11.5% in the SC group (P = 0.700). The time to first flatus (2.7 ± 2.0 vs. 4.5 ± 4.6 days, P = 0.010) and time to a semi-liquid diet (3.2 ± 2.1 vs. 6.3 ± 4.9 days, P < 0.001) in the ERAS group were shorter compared with those in the SC group. On the 10^th day after surgery, the values of weight, total protein, albumin, and prealbumin of the ERAS group were lower compared with those of the SC group.

Patients who received neoadjuvant chemotherapy could be enrolled into ERAS programs for locally advanced gastric cancer. The nutritional status of these patients was not adversely affected.

The aim of the study was to evaluate the long-term safety and efficacy of the Trabectome for Chinese glaucoma patients.

This was a multicenter, retrospective, observational study. Glaucoma patients, except those with neovascular glaucoma, with/without a visually significant cataract were enrolled. The patients received Trabectome or a combined surgery with phacoemulsification and intraocular lens implantation. The primary outcome evaluation was a reduction in intraocular pressure (IOP), and the secondary outcomes were a reduction in glaucoma medication, the 2-year success percentages, and complications. Success was defined as an IOP <21 mmHg and at least a 20% IOP reduction from baseline after 3 months for any two consecutive visits, without additional glaucoma surgery. The data were processed using the R Stats Package version 3.0.0. The Wilcoxon test was used to compare the postoperative IOP and the number of glaucoma medications with baselines. The Kaplan–Meier test was used to calculate the 2-year success percentage. The risk factors related to Trabectome failure were determined by logistic regression.

A total of 120 glaucoma patients were enrolled. The Trabectome efficiently reduced the IOP from a baseline of 22.8 ± 1.34 mmHg to 17.6 ± 0.96 mmHg, and the use of glaucoma medications from 2.2 ± 0.17 mmHg to 1.4 ± 0.21 in a 2-year follow-up (both, P < 0.01). The overall success percentage was 80%. No risk factor related to Trabectome failure was identified. No vision-threatening complication was observed. Ten patients, who required secondary glaucoma surgery, all reached the target IOP.

In a 2-year follow-up, Trabectome was an efficient and safe procedure for Chinese glaucoma patients.

Although many previous studies have confirmed that perioperative blood transfusion is associated with poor outcomes after liver transplantation (LT), few studies described the influence of single-donor platelet apheresis transfusion in living donor LT (LDLT). This study aimed to assess the effect of blood products on outcomes for LDLT recipients, focusing on apheresis platelets.

This retrospective study included 126 recipients who underwent their first adult-to-adult LDLT. Twenty-four variables including consumption of blood products of 126 LDLT recipients were assessed for their link to short-term outcomes and overall survival. Kaplan-Meier survival curve and the log-rank test were used for recipient survival analysis. A multivariate Cox proportional-hazard model and a propensity score analysis were applied to adjust confounders after potential risk factors were identified by a univariate Cox analysis.

Patients who received apheresis platelet transfusion had a lower 90-day cumulative survival (78.9% vs. 94.2%, P = 0.009), but had no significant difference in overall survival in the Cox model, compared with those without apheresis platelet transfusion. Units of apheresis platelet transfusion (hazard ratio [HR] = 3.103, 95% confidence interval [CI]: 1.720–5.600, P < 0.001) and preoperative platelet count (HR = 0.170, 95% CI: 0.040–0.730, P = 0.017) impacted 90-day survival independently. Multivariate Cox regression analysis also found that units of red blood cell (RBC) transfusion (HR = 1.036, 95% CI: 1.006–1.067, P = 0.018), recipient’s age (HR = 1.045, 95% CI: 1.005–1.086, P = 0.025), and ABO blood group comparison (HR = 2.990, 95% CI: 1.341–6.669, P = 0.007) were independent risk factors for overall survival after LDLT.

This study suggested that apheresis platelets were only associated with early mortality but had no impact on overall survival in LDLT. Units of RBC, recipient’s age, and ABO group comparison were independent predictors of long-term outcomes.

The pathogenesis of postural tachycardia syndrome (POTS) remains unclear. This study aimed to explore the changes and significance of sulfur dioxide (SO₂) in patients with POTS.

The study included 31 children with POTS and 27 healthy children from Peking University First Hospital between December 2013 and October 2015. A detailed medical history, physical examination results, and demographic characteristics were collected. Hemodynamics was recorded and the plasma SO₂ was determined.

The plasma SO₂ was significantly higher in POTS children compared to healthy children (64.0 ± 20.8 μmol/L vs. 27.2 ± 9.6 μmol/L, respectively, P < 0.05). The symptom scores in POTS were positively correlated with plasma SO₂ levels (r = 0.398, P < 0.05). In all the study participants, the maximum heart rate (HR) was positively correlated with plasma levels of SO₂ (r = 0.679, P < 0.01). The change in systolic blood pressure from the supine to upright (ΔSBP) in POTS group was smaller than that in the control group (P < 0.05). The ΔSBP was negatively correlated with baseline plasma SO₂ levels in all participants (r = −0.28, P < 0.05). In the control group, ΔSBP was positively correlated with the plasma levels of SO₂ (r = 0.487, P < 0.01). The change in HR from the supine to upright in POTS was obvious compared to that of the control group. The area under curve was 0.967 (95% confidence interval: 0.928–1.000), and the cutoff value of plasma SO₂ level >38.17 μmol/L yielded a sensitivity of 90.3% and a specificity of 92.6% for predicting the diagnosis of POTS.

Increased endogenous SO₂ levels might be involved in the pathogenesis of POTS.

Rosai-Dorfman disease (RDD) is typically characterized by painless bilateral and symmetrical cervical lymphadenopathy, with associated fever and leukocytosis. The aim of the current study was to summarize the clinical features and imaging characteristics of RDD, in an effort to improve its diagnostic accuracy.

The study was analyzed from 32 patients between January 2011 and December 2017; of these, 16 patients had pathologically diagnosed RDD, eight had pathologically diagnosed meningioma, and eight pathologically diagnosed lymphoma. All patients underwent computed tomography and magnetic resonance imaging (MRI). Clinical features and imaging characteristics of RDD were analyzed retrospectively. The mean apparent diffusion coefficient (ADC) values of lesions at different sites were measured, and one-way analysis of variance and the least significant difference t-test were used to compare the differences between groups and draw receiver operating characteristic curves. The tumors were excised for biopsy and analyzed using immunohistochemistry.

The mean ADCs were (0.81 ± 0.10) × 10⁻³ mm²/s for intercranial RDD, (0.73 ± 0.05) × 10⁻³ mm²/s for nasopharyngeal RDD, (0.74 ± 0.11) × 10⁻³ mm²/s for bone RDD, and (0.71 ± 0.04) × 10⁻³ mm²/s for soft-tissue RDD. The optimum ADC to distinguish intracranial RDD from lymphoma was 0.79 × 10⁻³ mm²/s (62.5% sensitivity and 100% specificity) and to distinguish meningioma from intracranial RDD was 0.92 × 10⁻³ mm²/s (62.5% sensitivity and 100% specificity). Levels of C-reactive protein, erythrocyte sediment rate and D-dimer were significantly elevated (81%, 87%, and 75%, respectively). On immunohistochemistry, RDD was positive for both S-100 and CD68 proteins but negative for CD1a.

Conventional MRI, combined with diffusion-weighted imaging and ADC mapping, is an important diagnostic tool in evaluating RDD patients. An accurate diagnosis of RDD should consider the clinical features, imaging characteristics, and the pathological findings.

Pompe disease is a rare lysosomal glycogen storage disorder linked to the acid alpha-glucosidase gene (GAA). A wide clinical and genetic variability exists between patients from different ethnic populations, and the genotype-phenotype correlations are still not well understood. The aim of this study was to report the clinicopathological and genetic characteristics of five Chinese patients with late-onset Pompe disease (LOPD) who carried novel GAA gene mutations.

Clinical and pathological data of patients diagnosed with glycogen storage disease at our institution from April 1986 to August 2017 were collected, and next-generation sequencing of frozen muscle specimens was conducted.

Of the five patients included in the study, the median disease onset age was 13 years, with a median 5 years delay in diagnosis. The patients mainly manifested as progressive weakness in the proximal and axial muscles, while one patient developed respiratory insufficiency that required artificial ventilation. In muscle biopsies, vacuoles with variable sizes and shapes appeared inside muscle fibers, and they stained positive for both periodic acid-Schiff and acid phosphatase staining. Ten GAA gene mutations, including seven novel ones (c.796C>A, c.1057C>T, c.1201C>A, c.1780C>T, c.1799G>C, c.2051C>A, c.2235dupG), were identified by genetic tests.

The seven novel GAA gene mutations revealed in this study broaden the genetic spectrum of LOPD and highlight the genetic heterogeneity in Chinese LOPD patients.

Dementia is the fourth most common cause of death in developed countries. The relationship between plasma lipids and cognitive function is complex and controversial. Due to the increasing life expectancy of the population, there is an urgent need to control vascular risk factors and to identify therapies to prevent and treat both cognitive impairment and dementia. Here, we reviewed the effects of plasma lipids and statins on cognitive function.

We searched the PubMed database for research articles published through November 2017 with key words including "plasma lipids," "hyperlipidemia," "hypercholesterolemia," "statins," and "cognition function."

Articles were retrieved and reviewed to analyze the effects of plasma lipids and statins on cognitive function and the mechanisms underlying these effects.

Many studies have examined the relationship between plasma lipids and cognitive function, but no definitive conclusions can be drawn. The mechanisms involved may include blood-brain barrier injury, the influence on small blood vessels in the brain, the influence on amyloid deposition, and a neuroprotective effect. To date, most studies of statins and cognition have been observational, with few randomized controlled trials. Therefore, firm conclusions regarding whether mid- or long-term statin use affects cognition function and dementia remain elusive. However, increasing concern exists that statins may be a causative factor for cognitive problems. These adverse effects appear to be rare and likely represent a yet-to-be-defined vulnerability in susceptible individuals.

The association between plasma lipids and cognition, the mechanism of the influence of plasma lipids on cognitive function, and the association between statins and cognitive function are complex issues and currently not fully understood. Future research aimed at identifying the mechanisms that underlie the effects of plasma lipids and statins on cognition will not only provide important insight into the causes and interdependencies of cognitive impairment and dementia, but also inspire novel strategies for treating and preventing these cognitive disorders.

Myotonia congenita (MC) is a group of genetically and clinically heterogeneous congenital neuromuscular channelopathies, typically characterized by the delayed relaxation of the muscles after voluntary contraction, stiffness, hypertrophy, transient weakness, and cramping. MC is caused by mutations in the skeletal muscle chloride channel gene (CLCN1[OMIM 118425]) and the skeletal muscle sodium channel gene (SCN4A[OMIM 603967]). The Nav1.4 voltage-gated sodium channel encoded bySCN4Ais a transmembrane complex that consists of an α subunit associated with an auxiliary β subunit in the muscle. The α subunit is composed of four homologous domains (I–IV), and each domain contains six α-helical transmembrane segments (S1–S6). Mutations clustered in specific areas of the Nav1.4 channel associate with distinct phenotypes according to their positions in the protein.

To the Editor: Vitiligo is not a fatal disease; however, it can have strong social and psychological impacts on the patients. Genetic susceptibility, autoimmunity, neural dysregulation, melanin self-destruction, and oxidative stress may be involved in the pathogenesis of vitiligo. Based on its clinical development, vitiligo can be divided into the progressive vitiligo (PV) or the stable vitiligo (SV). To date, at least 50 susceptible genes had been found in vitiligo.^[1]However, only a few genes presented a clear association with the high inherent risk of vitiligo and the protein levels of these genes were scarce. Recently, combination methods had been introduced in order to obtain better results. Nevertheless, no validated tool could confirm on the stage of vitiligo. Proteomics is a useful tool for large-scale screening of disease-related proteins. It could provide a better understanding of the biological and molecular events for this disease. Isobaric tag for relative and absolute quantitation (iTRAQ) is a systematic protein quantitative analytical method. It has the highest flux, the smallest system error, and the most powerful function for diagnosis, treatment, and prognosis. In this study, we identified differentially expressed proteins using iTRAQ-based proteomic technology and constructed an interaction network for SV and PV with the aim to identify potential group proteins as markers to distinguish between SV and PV.

To the Editor: Catheters are frequently used as diagnostic and therapeutic devices that are frequently placed in critically ill patients. In addition, with the advantage of radiologic technology, the number of minimally invasive endovascular procedures has increased, and consequently the reports of intravascular foreign bodies (IFBs)^[1,2]and the numerous described IFBs retrieval technique.^[3]Despite the importance of the subject, there is a lack in the reports of iatrogenic IFBs in Mexico; therefore, we report our experience in the management of adult patients with this complication and described a new IFBs removal technique.

To the Editor:Chlamydiaorganisms belong to intracellular bacterial pathogens which are responsible for a range of human diseases, including trachoma, sexually transmitted disease, pneumonia, and other diseases.^[1,2,3,4,5]SomeChlamydia-infected diseases were old and had long time impacted on the people’s health in China and worldwide, but people cannot put enough emphasis on it in local areas.^[6]For example, although China had reached the goal of eliminating blinding trachoma in 2015, some sporadic cases also exist in rural counties. Moreover, few of studies were conducted on pneumonia induced byChlamydiain China due to the present low prevalence and the limited detective methods. Sexually transmittedChlamydia trachomatisinfection also has notorious effects on reproduction, often asymptomatic and recurrent; thus, chlamydial infection diseases remain important public health concern over its prevention and control. This article focuses on the importance of caring aboutChlamydiaspp.and discusses taxonomy, prevalence, and laboratory diagnosis methods ofChlamydiadiseases in China.

To the Editor: Lymphangioma circumscriptum (LC) is not a tumor but rather a congenital malformation of the superficial lymphatics. It presents as groups of deep-seated, vesicle-like papules, resembling frog spawn, at birth or shortly thereafter. Also, the sites of predilection are the abdomen, axillae, genitalia, and mouth, particularly the tongue.^[1]Klippel-Trenaunay syndrome (KTS) is relatively rare as a congenital vascular anomaly classically defined as the triad of vascular stain, venous varicosities, soft tissue, and/or bony hypertrophy. Many cases of KTS are mixed malformations with capillary, lymphatic, and venous elements.^[2]Here, we reported a Chinese woman with vulvar LC coexisting with KTS in the same side of body.

To the Editor: The development of gut microbiota in the early years of life is essential for immune function and protection against pathogens in humans.^[1,2]Stool sample is often the first choice for analysis of the gut microbiota. The dominant five phyla observed in stool samples have beenFirmicutes,Bacteroidetes,Proteobacteria,Actinobacteria, andFusobacteria, ranked in the order of abundance. However, it might be difficult to obtain the fresh stool sample from infants and young children, especially when they are diseased. In this study, we aimed to evaluate if the rectal swab sample collected from children with hand, foot, and mouth disease (HFMD) can be an alternative for microbiome study using 16S rRNA gene sequencing technology.

To the Editor: Mantle cell lymphoma (MCL) is a non-Hodgkin’s lymphoma (NHL) subtype and considered one of the most aggressive lymphomas with worse prognosis than other subtypes of NHL.^[1]Despite the great progress over the last several decades, treatment of MCL still has troubles in survival, relapse, and drug resistance. Hence, extensive efforts are still needed in developing new agents for MCL. Recently, wogonin, as a major active ingredient of Scutellaria, has attracted considerable attention because of its antineoplastic properties and low toxicity.^[2]Previous studies have demonstrated that wogonin has cytotoxic effects on several cancer cell lines. However, the antitumor effect of wogonin on MCL cells has seldom been reported so far. In this study, we report that MCL cells, including Mino, JeKo-1, and REC-1 cells, are sensitive to wogonin and the possible involved mechanisms are also explored.

To the editor: Patients undergoing maintenance hemodialysis (MHD) are more vulnerable to nosocomial infection, with less ability to combat the infection and a greater susceptibility to contaminants in the dialysis environment. Infection is a frequent cause of hospitalization, second only to cardiovascular disease (CVD) as the leading cause of death in dialysis patients. Data from the United States Renal Data System indicated that 27.9% of MHD patients were diagnosed with pneumonia during their 1^styear of hemodialysis (HD).^[1]At present, in China, hospital-based HD facilities are fully occupied, with HD patients accounting for 86% of the dialysis population.^[2]Surprisingly, increasing pneumonia-related morbidity and mortality rates among MHD patients has received little attention, which is confirmed by our PubMed search results (45 citations, August 31, 2017).

To the Editor: Endometriosis is a common gynecologic condition that affects approximately 10% of females of reproductive age.^[1]It is a chronic inflammatory disease that is defined by the presence of endometrial-like tissue outside the uterine cavity. Endometriosis commonly occurs in the peritoneum, ovaries, and rectovaginal septum, but may also be found in other abdominal or extra-abdominal sites. Clinically, the symptoms of endometriosis include dysmenorrhea, pelvic pain, deep dyspareunia, and particularly infertility. It is well recognized that pregnancy can relieve endometriosis-related symptoms and may lead to the curation of endometriosis. Pregnancy is therefore considered as one of the therapeutic options for this disease. Whereas the relationship between endometriosis and infertility has been extensively studied, the influence of endometriosis on pregnancy complications remains elusive, which needs to be explored.