2018年 · 第131卷第11期

Despite recent advances that have improved the pregnancy success rates that can be achieved via in vitro fertilization (IVF) therapy, it is not yet clear which blastocyst morphological parameters best predict the outcomes of single blastocyst transfer. In addition, most of the previous studies did not exclude the effect of embryo aneuploidy on blastocysts transfer. Thus, the present study investigated the predictive value of various parameters on the pregnancy outcomes achieved via the transfer of frozen euploid blastocysts.

The study retrospectively analyzed 914 single euploid blastocyst transfer cycles that were performed at the Peking University Third Hospital Reproductive Medical Center between June 2011 and May 2016. The expansion, trophectoderm (TE), and inner cell mass (ICM) quality of the blastocysts were assessed based on blastocyst parameters, and used to differentiate between "excellent", "good", "average", and "poor" -quality embryos. The relationship between these embryo grades and the achieved pregnancy outcomes was then analyzed via the Chi-square and logistic regression tests.

For embryo grades of excellent, good, average and poor, the clinical pregnancy rates were 65.0%, 59.3%, 50.3% and 33.3%, respectively; and the live-birth rates were 50.0%, 49.7%, 42.3% and 25.0%, respectively. Both the clinical pregnancy rate (χ² = 21.28, P= 0.001) and live-birth rate (χ² = 13.50, P< 0.001) increased with the overall blastocyst grade. Both rates were significantly higher after the transfer of a blastocyst that exhibited either an A-grade or B-grade TE, and similarly, an A-grade ICM, than after the transfer of a blastocyst that exhibited a C-grade TE and/or ICM. The degree of blastocyst expansion had no apparent effect on the clinical pregnancy or live-birth rate. All odds ratio were adjusted for patient age, body mass index, length (years) of infertility history, and infertility type.

A higher overall euploid blastocyst quality is shown to correlate most strongly with optimal pregnancy outcomes. The study thus supports the use of the described TE and ICM morphological grades to augment current embryo selection criteria.

The introduction of individualized abdominoperineal excision (APE) may minimize operative trauma and reduce the rate of complications. The purpose of this study was to evaluate the safety and efficacy of individualized APE for low rectal cancer.

Fifty-six patients who underwent individualized APE from June 2011 to June 2015 were evaluated retrospectively in Beijing Chaoyang Hospital, Capital Medical University. The main outcome measures were circumferential resection margin (CRM) involvement, intraoperative perforation, postoperative complications, and local recurrence. Statistical analysis was performed using SPSS version 16.0.

Fifty (89%) patients received preoperative chemoradiotherapy: 51 (91%) patients were treated with the sacrococcyx preserved; 27 (48%) patients with the levator ani muscle partially preserved bilaterally; 20 (36%) patients with the levator ani muscle partially preserved unilaterally and the muscle on the opposite side totally preserved; 7 (13%) patients with intact levator ani muscle and part of the ischioanal fat bilaterally dissected; and 2 (4%) patients with part of the ischioanal fat and intact lavator ani muscle dissected unilaterally and the muscle on the opposite side partially preserved. The most common complications included sexual dysfunction (12%), perineal wound complications (13%), urinary retention (7%), and chronic perineal pain (5%). A positive CRM was demonstrated in 3 (5%) patients, and intraoperative perforations occurred in 2 (4%) patients. On multiple logistic regression analysis, longer operative time (P = 0.032) and more intraoperative blood loss (P = 0.006) were significantly associated with perineal procedure-related complications. The local recurrence was 4% at a median follow-up of 53 months (range: 30- 74 months).

With preoperative chemoradiotherapy, individualized APE may be a relatively safe and feasible approach for low rectal cancer with acceptable oncological outcomes.

Lupus nephritis (LN) is classified by renal biopsy into proliferative and nonproliferative forms, with distinct prognoses, but renal biopsy is not available for every LN patient. The present study aimed to establish an alternate tool by building a predictive model to evaluate the probability of proliferative LN.

In this retrospective cohort with biopsy-proven LN, 382 patients in development cohort, 193 in internal validation cohort, and 164 newly diagnosed patients in external validation cohort were selected. Logistic regression model was established, and the concordance statistics (C-statistics), Akaike information criterion (AIC), integrated discrimination improvement, Hosmer-Lemeshow test, and net reclassification improvement were calculated to evaluate the performance and validation of models.

The prevalence of proliferative LN was 77.7% in the whole cohort. A model, including age, gender, systolic blood pressure, hemoglobin, proteinuria, hematuria, and serum C3, performed well on good-of-fit and discrimination in the development chohort to predict the risk of proliferative LN (291 for AIC and 0.84 for C-statistics). In the internal and external validation cohorts, this model showed good capability for discrimination and calibration (0.84 and 0.82 for C-statistics, and 0.99 and 0.75 for Pvalues, respectively).

This study developed and validated a model including demographic and clinical indices to evaluate the probability of presenting proliferative LN to guide therapeutic decisions and outcomes.

Serum soluble ST2 (sST2) levels are elevated early after acute myocardial infarction and are related to adverse left ventricular (LV) remodeling and cardiovascular outcomes in ST-segment elevation myocardial infarction (STEMI). Beta-blockers (BB) have been shown to improve LV remodeling and survival. However, the relationship between sST2, final therapeutic BB dose, and cardiovascular outcomes in STEMI patients remains unknown.

A total of 186 STEMI patients were enrolled at the Wuhan Asia Heart Hospital between January 2015 and June 2015. All patients received standard treatment and were followed up for 1 year. Serum sST2 was measured at baseline. Patients were divided into four groups according to their baseline sST2 values (high >56 ng/ml vs. low ≤56 ng/ml) and final therapeutic BB dose (high ≥47.5 mg/d vs. low <47.5 mg/d). Cox regression analyses were performed to determine whether sST2 and BB were independent risk factors for cardiovascular events in STEMI.

Baseline sST2 levels were positively correlated with heart rate (r = 0.327, P= 0.002), Killip class (r = 0.408, P= 0.000), lg N-terminal prohormone B-type natriuretic peptide (r = 0.467, P= 0.000), lg troponin I (r = 0.331, P= 0.000), and lg C-reactive protein (r = 0.307, P= 0.000) and negatively correlated to systolic blood pressure (r= −0.243, P = 0.009) and LV ejection fraction (r= −0.402, P = 0.000). Patients with higher baseline sST2 concentrations who were not titrated to high-dose BB therapy (P < 0.0001) had worse outcomes. Baseline high sST2 (hazard ratio [HR]: 2.653; 95% confidence interval [CI]: 1.201–8.929; P= 0.041) and final low BB dosage (HR: 1.904; 95% CI, 1.084–3.053; P= 0.035) were independent predictors of cardiovascular events in STEMI.

High baseline sST2 levels and final low BB dosage predicted cardiovascular events in STEMI. Hence, sST2 may be a useful biomarker in cardiac pathophysiology.

Development of innovative immunotherapy is imperative to improve the poor survival of the nasopharyngeal carcinoma (NPC ) patients. In this study, we evaluated the T cell response to melanoma-associated antigen (MAGE)-A1, MAGE-A3, or synovial sarcoma X-2 (SSX-2) in the peripheral blood of treatment-naive NPC patients. The relationship of responses among the three proteins and the human leukocyte antigen (HLA)-A types were analyzed to provide evidence of designing novel therapy.

Sixty-one NPC patients admitted into the Tumor Hospital affiliated to the Xinjiang Medical University between March 2015 and July 2016 were enrolled. Mononuclear cells were isolated from the peripheral blood before any treatment. HLA-A alleles were typed with Sanger sequence-based typing technique. The T cell response to the MAGE-A1, MAGE-A3, or SSX-2 was evaluated with the Enzyme-Linked ImmunoSpot assay. Mann-Whitney U-test was used to compare the T cell responses from different groups. Spearman’s rank correlation was used to analyze the relationship of T cell responses.

HLA-A*02:01, A*02:07, and A*24:02 were the three most frequent alleles (18.9%, 12.3%, and 11.5%, respectively) among the 22 detected alleles. 31.1%, 19.7%, and 16.4% of the patients displayed MAGE-A1, MAGE-A3, or SSX-2-specific T cell response, respectively. The magnitudes of response to the three proteins were 32.5, 38.0, and 28.7 SFC/10⁶ peripheral blood mononuclear cells, respectively. The T cell response against the three proteins correlated with each other to different extent. The percentage of A*02:01 and A*24:02 carriers were significantly higher in patients responding to any of the three proteins compared to the nonresponders.

MAGE-A1, MAGE-A3, or SSX-2-specific T cell responses were detectable in a subgroup of NPC patients, the frequency and magnitude of which were correlated.

Patellar dislocation is one of the most common knee injuries in the adolescent population. It is often combined with osteochondral fracture. The purpose of this study was to compare the outcomes between fixation and excision of osteochondral fractures not involving the bearing surface in adolescent patients with patellar dislocations.

Patients who underwent surgery for osteochondral fracture following patellar dislocation in our institution from 2007 to 2014 were retrospectively evaluated. Visual analog scale (VAS) of pain and the International Knee Documentation Committee (IKDC) form were used to assess knee pain and function at follow-up. Patient satisfaction was evaluated. Differences in the values of variables among groups were assessed using t-test if equal variance or Mann–Whitney U-test if not equal variance. The Pearson’s Chi-square test was applied for dichotomous variables if expected frequency was >5 or Fisher’s exact test was applied if not. A value of P < 0.05 was considered statistically significant.

Forty-three patients were included, with the average age of 14.1 ± 2.3 (range, 9.0–17.0) years. Nineteen underwent fixation of osteochondral fractures and 24 did not. The average follow-up time was 28 ± 10 months. There was no significant difference in age, gender, follow-up time, causes of injury, times of dislocation, and location of osteochondral fracture between fixation and excision groups. The fixation group had a significantly longer surgery time (82 ± 14 min) and larger size of osteochondral fracture (2.30 ± 0.70 cm²) than the excision group (43 ± 10 min, 1.88 ± 0.62 cm², respectively, t = 10.77, P < 0.01 and t = 0.84, P < 0.05). At the last follow-up, the average IKDC score in the fixation group (82.52 ± 8.71) was significantly lower than that in the excision group (89.51 ± 7.19, t= 2.65, P < 0.01). There was no significant difference in VAS of pain and patients’ satisfaction. There were 7 (16%) patients with recurrent dislocation.

Excision of osteochondral fractures has equivalent or better outcomes compared to fixation in adolescent patients with patellar dislocations when these fractures do not involve the bearing surface.

Immunosuppressive agents are still inefficient in preventing biopsy-proven acute rejection (BPAR) after expanded criteria donor (ECD) kidney transplantation. The aim of this study was to investigate the relationships between early immunosuppressive exposure and the development of BPAR.

We performed a retrospective study of 58 recipients of ECD kidney transplantation treated with enteric-coated-mycophenolate sodium, tacrolimus (Tac), and prednisone. The levels of mycophenolic acid-area under the curve (MPA-AUC)_0-12h and Tac C₀ were measured at the 1^st week and the 1^st month posttransplant, respectively. The correlation was assessed by multivariate logistic regression.

The occurrence rates of BPAR and antibody-mediated rejection were 24.1% and 10.3%, respectively. A low level of MPA-AUC_0-12hat the 1^st week posttransplant was found in BPAR recipients (38.42 ± 8.37 vs. 50.64 ± 13.22, P < 0.01). In addition, the incidence of BPAR was significantly high (P < 0.05) when the MPA-AUC_0-12h level was <30 mg·h^-1∙L^-1 at the 1^st week (15.0% vs. 44.4%) or the Tac C₀was <4 ng/ml at the 1^st month posttransplant (33.3% vs. 21.6%). Multivariable logistic regression analysis showed that the MPA-AUC_0-12hat the 1^st week (OR: 0.842, 95% CI: 0.784-0.903) and the Tac C₀at the 1^st month (OR: 0.904, 95% CI: 0.822- 0.986) had significant inverse correlation with BPAR (P < 0.05).

Low-level exposure of MPA and Tac C₀ in the early weeks posttransplant reflects an increased acute rejection risk, which suggested that MPA-AUC_0-12h <30 mg·h^-1∙L^-1 and Tac C₀ <4 ng/ml should be avoided in the first few weeks after transplantation.

When considering the issue of recurrence, perimenopausal women may have more dilemma during management comparing with young women, for example, whether to retain the uterus and ovary during surgery, whether it is necessary to add adjuvant medicine treatment after operation, and there is no evidence for reference about using of gonadotropin-releasing hormone agonist. This study aimed to study the risk factors for the recurrence of ovarian endometriosis (EM) in patients aged 45 and over.

This is a retrospective nested case-control study. We reviewed the medical records of patients aged over 45 years who underwent surgical treatments for ovarian EM from 1994 to 2014, in Peking Union Medical College Hospital of Chinese Academy of Medical Sciences. By following up to January 2016, 45 patients were found to have relapses and regarded as the recurrence group. The patients with no recurrence during the same follow-up period were randomly selected by the ratio of 1:4 as the nonrecurrence group (180 patients in total). Stratified Cox regression was used to analyze the risk factors of the recurrence.

Univariate analysis showed that there was a significant difference in the postoperative treatment (the percentage of patients who received postoperative treatment in non-recurrence group and recurrence group, 23.9% vs. 40.0%, χ² = 4.729, P = 0.030) and ovarian preservation (the percentage of patients who received surgery of ovarian preservation in non-recurrence group and recurrence group, 25.0 % vs. 44.4%, χ² = 19.462, P < 0.001) between the nonrecurrence group and the recurrence group. There was no correlation between recurrence and the following factors including patient’s age, menarche age, gravidity, parity, CA125 level, ovarian lesions, menopausal status, combined benign gynecological conditions (such as myoma and adenomyoma) and endometrial abnormalities, and surgical approach or surgical staging (all P> 0.05). Multivariate analysis indicated that whether to retain the ovary was the only independent risk factor of recurrence for patients aged 45 years and over with ovarian EM (odds ratio: 5.594, 95% confidence interval: 1.919- 16.310, P = 0.002). Conclusion: Ovarian preservation might be the only independent risk factor of recurrence for patients aged 45 years and over with ovarian EM.

Contribution of model for end-stage liver disease incorporating with serum sodium (MELD-Na) score in predicting acute kidney injury (AKI) after orthotopic liver transplantation (OLT) is yet to be identified. This study assessed the prognostic value of MELD-Na score for the development of AKI following OLT.

Preoperative and surgery-related variables of 321 adult end-stage liver disease patients who underwent OLT in Fuzhou General Hospital were collected. Postoperative AKI was defined and staged in accordance with the clinical practice guidelines developed by Kidney Disease: Improving Global Outcomes. Univariate and multivariate analysis was performed to determine the risk factors for AKI following OLT. The discriminating power of MELD/MELD-Na score on AKI outcome was evaluated by receiver operating characteristic (ROC) curve. Spearman’s correlation analysis was used for identifying the correlated relationship between MELD/MELD-Na score and the severity levels of AKI.

The prevalence of AKI following OLT was in 206 out of 321 patients (64.2%). Three risk factors for AKI post-OLT were presented, preoperative calculated MELD score (odds ratio [OR] = 1.048, P= 0.021), intraoperative volume of red cell suspension transfusion (OR = 1.001, P= 0.002), and preoperative liver cirrhosis (OR = 2.015, P= 0.012). Two areas under ROC curve (AUCs) of MELD/MELD-Na score predicting AKI were 0.688 and 0.672, respectively; the difference between two AUCs was not significant (Z = 1.952, P= 0.051). The Spearman’s correlation coefficients between MELD/MELD-Na score and the severity levels of AKI were 0.406 and 0.385 (P = 0.001, 0.001), respectively.

We demonstrated that preoperative MELD score, intraoperative volume of red cell suspension transfusion and preoperative liver cirrhosis were risk factors for AKI following OLT. Furthermore, we preliminarily validated that MELD score seemed to have a stronger power discriminating AKI post-OLT than that of novel MELD-Na score.

The diagnosis and treatment of small-bowel diseases is clinically difficult. The purpose of this study was to evaluate the diagnostic and therapeutic value of double-balloon enteroscopy in small-bowel diseases.

The history and outcomes of 2806 patients who underwent double-balloon enteroscopy from July 2004 to April 2017 were reviewed, which included 562 patients with obscure digestive tract bleeding, 457 patients with obscure diarrhea, 930 patients with obscure abdominal pain, 795 patients with obscure weight loss, and 62 patients with obscure intestinal obstruction. Examinations were performed through the mouth and/or anus according to the clinical symptoms and abdominal images. If a lesion was not detected through one direction, examination through the other direction was performed as necessary. Eighty-four patients with small-bowel polyps, 26 with intestinal obstruction caused by enterolith, and 18 with bleeding from Dieulafoy’s lesions in the small intestine were treated endoscopically.

A total of 2806 patients underwent double-balloon enteroscopy, and no serious complications occurred. An endoscopic approach through both the mouth and anus was used in 212 patients. Lesions were detected in 1696 patients, with a detection rate of 60.4%; the rates for obscure digestive tract bleeding, diarrhea, abdominal pain, weight loss, and intestinal obstruction were 85.9% (483/562), 73.5% (336/457), 48.2% (448/930), 49.1% (390/795), and 62.9% (39/62), respectively. For patients with small-bowel polyps who underwent endoscopic therapy, no complications such as digestive tract bleeding and perforation occurred. Intestinal obstruction with enteroliths was relieved with endoscopic lithotripsy.Among the 18 patients with bleeding from small-bowel Dieulafoy’s lesions, 14 patients were controlled with endoscopic hemostasis.

Double-balloon enteroscopy is useful for diagnosing and treating some small-bowel disease.

Increasing evidence has supported the link of intestinal Fusobacterium nucleatum infection to colorectal cancer (CRC). However, the value of F. nucleatum as a biomarker in CRC detection has not been fully defined. In order to reduce the random error and bias of individual research, this meta-analysis aimed to evaluate the diagnostic performance of intestinal F. nucleatum in CRC patients and provide evidence-based data to clinical practice.

An article search was performed from PubMed, Embase, Cochrane Library, and Web of Science databases up to December 2017, using the following key words: "Fusobacterium nucleatum", "Fusobacterium spp.", "Fn", "colorectal cancer(s)", "colorectal carcinoma(s)", "colorectal neoplasm(s)", and "colorectal tumor(s)". Articles on relationships between F. nucleatum and CRC were selected according to the preestablished inclusion and exclusion criteria. This meta-analysis was performed using STATA 12.0 software, which included mapping of forest plots, heterogeneity tests, meta-regression, subgroup analysis, sensitivity analysis, and publication bias. The sensitivity, specificity, positive likelihood ratio (LR), negative LR, diagnostic odds ratio (DOR), and their corresponding 95% confidence interval (CI) of each eligible study were summarized.

Finally, data for 1198 participants (629 CRC and 569 healthy controls) in 10 controlled studies from seven articles were included. The summary receiver operator characteristic curve was mapped. The diagnostic performance of intestinal F. nucleatum infection on CRC was as follows: the area under the curve: 0.86 (95% CI: 0.83- 0.89), the pooled sensitivity: 0.81 (95% CI: 0.64- 0.91), specificity: 0.77 (95% CI: 0.59- 0.89), and DOR: 14.00 (95% CI: 9.00–22.00).

Intestinal F. nucleatum is a valuable marker for CRC diagnosis.

Diabetic kidney disease (DKD) has become one of the major causes of end-stage renal disease. Urinary extracellular vesicles (uEVs) contain rich biological information which could be the ideal source for noninvasive biomarkers of DKD. This review discussed the potential early diagnostic and therapeutic values of proteins and microRNAs in uEVs in DKD.

This review was based articles published in PubMed, Embase, Cochrane, and Google Scholar databases up to November 20, 2017, with the following keywords: "Diabetic kidney disease", "Extracellular vesicle", and "Urine" .

Relevant articles were carefully reviewed, with no exclusions applied to the study design and publication type.

There is no "gold standard" technology to separate and/or purify uEVs. The uEVs contain a variety of proteins and RNAs and participate in the physiological and pathological processes of the kidney. UEVs, especially urinary exosomes, may be useful biomarkers for early diagnosis and treatment to DKD. Furthermore, the uEVs has been used as a therapeutic target for DKD.

Proteins and nucleic acids in uEVs represent promising biomarker for the diagnosis and treatment of DKD.

To the Editor: Rho GTPase Activating Protein 11A (ArhGAP11A) is a member of the Rho GTPase-activating proteins (Rho GAPs) gene family and is located on the long arm of 15 chromosome region 1 band 3 subband 2 (15q13.3). The full-length cDNA ofArhGAP11Ais 24,806 bp with a single open-reading frame.ArhGAP11Ais encoded by 13 exons and the encoded protein has three domains: a RhoGAP domain near the N terminus (amino acids 46–246), and two uncharacterized domains respectively located in the center (387–516) and C terminus (590–997) of the protein.^[1]Kagawaet al.^[2]compared the expression ofArhGAP11Ain 74 colorectal cancer tissue specimens and five noncancerous mucosal tissue specimens with cDNA microarray-based comparative analyses. The results showed thatArhGAP11Aexpression was significantly higher in colorectal cancer tissue than that in noncancerous tissue, indicating that the upregulation ofArhGAP11Aexpression is beneficial to colorectal cancer cellsin vivomigration and invasion activity. Cirielloet al.^[3]analyzed the RNA sequential data of 1201 patients with invasive breast lobular cancer, but only a few of the 64Rho GAPswere found to be highly expressed in the basal-like breast cancer. Further study^[4]showed that the expression ofArhGAP11Ain basal-like breast cancer was generally higher than other types of breast cancer, andin vitroexperiments showed thatArhGAP11Aoverexpression could stimulate normal breast cancer cell proliferation.ArhGAP11Aexpression was also found to be upregulated in glioblastoma, hepatocellular, and pancreatic cancers. Based on these findings, the abnormal expression ofArhGAP11Amight be closely related to the occurrence and development of tumors.

To the Editor: Distal pancreatectomy is one of the most commonly performed procedures for tumors involving the neck and body of the pancreas. Left-sided pancreatic resection reduces pancreatic function and is associated with an increased incidence of diabetes mellitus. Severe exocrine insufficiency has been reported more often after left-sided pancreatic resection than the following standard pancreatoduodenectomy. Tumor enucleation and middle segmental pancreatic resection (MSPR) were suggested by Begeret al.,^[1]especially for pancreatic benign tumors located in the neck and body of the pancreas. However, the high rate (>30%) of pancreatic fistula formation with pancreaticojejunal anastomosis has prevented widespread use of MSPR.^[1,2]So far, no better procedures have been described for pancreatic reconstruction. In this case series, we applied a new reconstructive technique, pancreaticojejunal bridge stent internal drainage (PJBSID) after MSPR and studied the postoperative outcomes.

To the Editor: Anthrax is a zoonosis to which most mammals, especially herbivores, are considered susceptible.^[1]Humans almost invariably contract anthrax from handling infected animals, from carcasses of animals that have died from the disease, or from the meat, skin, hair, bones, etc., of such animals.^[1,2]Guizhou Province is a historical epicenter of anthrax in the southwest of China.^[3]In June 2013, an epidemic suspected to be anthrax consisting of five human cases occurred in Wengan County. The clinical symptoms included erythema, papules, and vesicles on the skin of the hands and forearm, accompanied by tissue swelling, infiltration, central cutaneous necrosis, and ulcerative scabs, which are consistent with the Diagnostic Criteria for Anthrax (WS 283-2008). Five strains suspected to beBacillus anthraciswere collected from one of the five patients as well as from soil samples from this epidemic. To provide an etiologic basis for the diagnosis of patients and epidemics and to enhance our understanding of the genetic characteristics ofB. anthracisin Guizhou Province, a retrospective molecular epidemiological investigation was carried out on the five isolates collected in this epidemic.

To the Editor: Moderator band (MB) is a part of the septomarginal trabeculation, which not only supports the anterior papillary muscle (APM) of the tricuspid valve but also connects it to the free wall. Nevertheless, with the advent of intracardiac echocardiography (ICE), electrophysiologists are now aware of the arrhythmogenic role of MB besides its mechanical function. MB-originated ventricular tachycardia or ventricular fibrillation (VT/VF) is a kind of idiopathic malignant arrhythmia in the absence of structural heart disease, which is frequently triggered by a premature ventricular contraction (PVC) from the same site.^[1]As the mechanism of this kind of arrhythmia is not well illustrated, previous research has reported the involvement of the Purkinje system of the right ventricle (RV), although catheter radiofrequency (RF) ablation delivered to the site displaying Purkinje potential showed limited efficacy.^[2,3]Herein, we present a case of MB-originated VT/VF in a 29-year-old woman in whom ablation based on the anatomical substrate (free wall and septum insertions of MB) proved successfully.

To the Editor: A 58-year-old man with up to a 5-year history of cholecystolithiasis presented with a 1-day history of mild abdominal pain with tenderness in the right upper quadrant before this hospital admission. He complained of similar symptoms about 5 years ago and recovered after 11 days of conservative therapy in the same hospital. The temperature was normal, and no special findings were noted on laboratory testing. Ultrasonography revealed multiple small gallstones in the lumen of the gallbladder. Unexpectedly, augmented collaboration of the portal vein was demonstrated at the Calot triangle and the bed of the gallbladder during a laparoscopic cholecystectomy (LC) [Figure 1a]. The deformed veins appeared fragile and hence were very carefully separated and ligated using clips one by one. LC was performed with completion. The previous computerized tomography (CT) of the abdomen obtained postoperatively [Figure 1b] and 5 years ago [Figure 1c] were retrospectively reviewed. The previous CT [Figure 1c] showed a normal portal vein lumen and portal vein system, with the exception of a major portal vein thrombosis and a small pyogenic liver abscess due to acute cholecystitis, while the most recent CT [Figure 1b] revealed abnormalities of the portal vein. The postoperative pathologic evaluation confirmed numerous twisted, congestive veins around the surface of the specimen [gallbladder;Figure 1d].

To the Editor: Glycogen storage disease (GSD) is a group of inherited disorders with abnormal glycogen deposition.^[1]Pulmonary hypertension (PH) is a rare complication of GSD with unclear etiology. Since the pioneer description in 1980,^[2]only a few cases of GSD-associated PH have been reported. Here, we reported a Chinese case with informed consent by the patient and the guardian.

To the Editor: The gastrointestinal tract (GIT) is the most common extranodal location of non-Hodgkin’s lymphoma, but it represents only 0.4% of primary colonic malignancies.^[1]Symptoms are nonspecific and may include diarrhea, constipation, abdominal pain, weight loss, and gastrointestinal bleeding. In colon, the most common types are conventional large cell lymphoma, mucosa-associated lymphoid tissue lymphoma, and T-cell lymphoma.^[1,2,3]

To the Editor: A 70-year-old Chinese gentleman with end-stage renal disease on intermittent peritoneal dialysis (IPD) was admitted to nephrology ward for regular IPD therapy in August 2016. After admission, he presented sudden lower back pain with significant anemia. Computed tomography (CT) scan showed large amount of pericardial effusion, bilateral pleural effusion, and ascites in abdomen and pelvis. Later on, he was intubated with mechanical ventilation support and on continuous venovenous hemofiltration. Pericardiocentesis and thoracocentesis were performed. On the 9^thday of admission, angiography was arranged due to active bleeding. It showed bleeding point from the superior vena cava area, near the right atrium. Then, the patient received urgent cardiac surgery immediately.

To the Editor: The methods for obstruction of colon cancer include emergency surgery or self-expanding metallic stents (SEMSs). SEMS insertion was shown to be a safe, easy, and effective treatment for left-sided malignant colon obstruction, for palliative treatment or as bridge to resection.^[1,2,3,4,5]The cases reported of SEMS insertion in the colon proximal to the splenic flexure were <5% of all studies. The long distances and the tortuosity of the distal bowel make it difficult to advance and position the stent in the target proximal colon, and obstruction of right colon has traditionally been managed by acute operation. Stent implant for a proximal colon obstruction is a safe, feasible, and effective treatment for palliation or as a bridge to surgery, and a significantly higher morbidity and mortality was occurred in emergency right-sided colon resection compared with elective resections.^[1,2,3,4,5]

To the Editor: With great interest, we read the article "Multibacillary Leprosy in a Child" by Wanget al.^[1]The authors have nicely shown the rare presentation in highly unsuspected clinical dermatological case. Authors also have emphasized the importance of early biopsy including Fite-Faraco stain to make a diagnosis of multibacillary leprosy that is important in patients with only atypical cutaneous manifestations. In the case that discussed, the clinical finding suggests a clinical case of leprosy with eyebrows involvement and multiple nodular lesions except for the short duration. The child is diagnosed as a case of multibacillary child Hansen’s and was treated with multidrug therapy, consisting of monthly doses of rifampicin 450 mg and clofazimine 200 mg, plus daily doses of dapsone 50 mg, and clofazimine 50 mg. In view of this statement, we feel strongly that the author might tried to say regarding the standard child (ages 10–14 years) treatment regimen for multibacillary leprosy as rifampicin 450 mg once a month, clofazimine 150 mg once a month and 50 mg every other day, and dapsone 50 mg daily for 12 months^[2]instead of what it might be wrongly typed as above.

Thanks for your careful reading and priceless comments to our recent publication.^[1]Although the incidence and prevalence of leprosy have declined significantly in recent decades, leprosy will probably persist as a major health problem in the world, especially in Southeast Asia. We are glad to see that our paper about multibacillary leprosy in a child can be noticed by the readers.

In the article titled "Association of Source of Memory Complaints and Increased Risk of Cognitive Impairment and Cognitive Decline: A Community-Based Study" published on pages 894-898, Issue 8, Volume 131 ofChinese Medical Journal,^[1]the financial support is written incorrectly as "the National Program of Basic Research Natural Science (No. 81571135)" instead of "the National Program of Basic Research Natural Science (No. 81571103)" .