2018年 · 第131卷第14期

Whether there is a relationship between glomerular filtration rate (GFR) and hemorrhagic transformation (HT) after acute ischemic stroke (AIS) is still under debate. The aim of our study was to determine whether the GFR level is a predictor of HT in AIS patients without thrombolytic therapy (TT).

Consecutive AIS patients without TT were included in this prospective study from January 2014 to December 2016 in the First Affiliated Hospital of Chongqing Medical University. We divided them into two groups (HT and non-HT group) and meticulously collected baseline characteristics and laboratory and imaging data of interested individuals. Multivariate regression analysis was performed to assess the correlation between GFR and HT in stroke patients without TT.

Among 426 consecutive patients, 74 (17.3%) presented HT (mean age: 65 ± 12 years, number of male patients: 47) on the follow-up scans. In multivariate regression analysis, HT was significantly associated with low GFR (odds ratio [OR] = 3.708, confidence interval [CI] = 1.326–10.693, P = 0.013), atrial fibrillation (AF; OR = 2.444, CI = 1.087–5.356, P = 0.027), large cerebral infarction (OR = 2.583, CI = 1.236–5.262, P = 0.010), and hypoalbuminemia (HA; OR = 4.814, CI = 1.054–22.153, P = 0.037) for AIS patients without TT.

The present study strongly showed that lower GFR is an independently predictor of HT; in addition, large infarct volume, AF, and HA are also important risks of HT for AIS patients without TT, which offered a practical information that risk factors should be paid attention or eliminated to prevent HT for stroke patients though the level of evidence seems to be unstable.

Until now, various types of combined therapy with nucleotide analogs and pegylated interferon (Peg-INF) in patients with hepatitis B patients have been tried. However, studies regarding the benefits of de novo combination, late-add on, and sequential treatment are very limited. The objective of the current study was to identify the efficacy of sequential treatment of Peg-INF after short-term antiviral treatment.

Between June 2010 and June 2015, hepatitis B e antigen (HBeAg)-positive patients (n = 162) received Peg-IFN for 48 weeks (mono-treatment group, n = 81) and entecavir (ETV) for 12 weeks with a 48-week course of Peg-IFN starting at week 5 of ETV therapy (sequential treatment group, n = 81). The primary endpoint was HBeAg seroconversion at the end of follow-up period after the 24-week treatment. The primary endpoint was analyzed using Chi-square test, Fisher’s exact test, and regression analysis.

HBeAg seroconversion rate (18.2% vs. 18.2%, t= 0.03, P = 1.000) and seroclearance rate (19.7% vs. 19.7%, t= 0.03, P = 1.000) were same in both mono-treatment and sequential treatment groups. The rate of alanine aminotransferase (ALT) normalization (45.5% vs. 54.5%, t = 1.12, P = 0.296) and serum hepatitis B virus (HBV)-DNA <2000 U/L (28.8% vs. 28.8%, t = 0.10, P = 1.000) was not different in sequential and mono-treatment groups at 24 weeks of Peg-INF. Viral response rate (HBeAg seroconversion and serum HBV-DNA <2000 U/L) was not different in the two groups (12.1% vs. 16.7%, t = 1.83, P = 0.457). Baseline HBV-DNA level (7 log₁₀ U/ml vs. 7.5 log₁₀ U/ml, t = 1.70, P = 0.019) and hepatitis B surface antigen titer (3.6 log₁₀ U/ml vs. 4.0 log₁₀ U/ml, t = 2.19, P = 0.020) were lower and predictors of responder in mono-treatment and sequential treatment groups, respectively.

The current study shows no differences in HBeAg seroconversion rate, ALT normalization, and HBV-DNA levels between mono-therapy and sequential therapy regimens.

ClinicalTrials.gov, NCT01220596; https://clinicaltrials.gov/ct2/show/NCT01220596?term=NCT01220596&rank=1.

Although fasting plasma glucose (FPG) has been highly recommended as the sole test for diabetes screening, the efficacy of FPG alone for diabetes screening is potentially limited due to its low sensitivity. The aim of this study was to improve the efficacy of FPG for diabetes screening using urinary glucose (UG).

This study was initiated on November 12, 2015, and ended on June 28, 2016. A representative sample of individuals aged between 18 and 65 years, with no history of diabetes, from 6 cities in Jiangsu Province participated in this study. A 75-g oral glucose tolerance test was used to diagnose diabetes. All urine samples were collected within 2 h of oral glucose loading to measure UG. Partial correlation analyses were used to evaluate the associations between UG and other glycemic variables, including FPG, 2-h plasma glucose (2h-PG), and glycated hemoglobin A1c, after adjustment for age. The performance of UG was evaluated using a receiver operating characteristic (ROC) curve analysis.

Of the 7485 individuals included, 8% were newly diagnosed with diabetes and 48.7% had prediabetes. The areas under the ROC curves for UG were 0.75 for estimation of 2h-PG ≥7.8 mmol/L and 0.90 for 2h-PG ≥11.1 mmol/L, respectively. The sensitivity and specificity of UG were 52.3% and 87.8%, respectively, for 2h-PG ≥7.8 mmol/L (cutoff point ≥130 mg), and 83.5% and 87.5%, respectively, for 2h-PG ≥11.1 mmol/L (cutoff point ≥178.5 mg). The combination of FPG and UG demonstrated a significantly higher sensitivity than that of FPG alone for the identification of diabetes ([483/597] 80.9% vs. [335/597] 56.1%, χ² = 85.0, P < 0.001) and glucose abnormalities ([2643/4242] 62.3% vs. [2365/4242] 55.8%, χ² = 37.7, P < 0.001).

The combination of UG and FPG substantially improves the efficacy of using FPG alone for diabetes screening; this combination might be a practical screening tool and is worth being recommended in the future.

Infectious endophthalmitis is a severe ocular inflammation which can cause devastating visual loss. The aim of the study was to identify the demographic and clinical features of infectious endophthalmitis in Western China for better prophylaxis and treatment of this disease.

A retrospective, cross-sectional study was conducted based on the medical records of inpatients having infectious endophthalmitis in a tertiary referral center in Western China between 2005 and 2016.

The common cause of infectious endophthalmitis was trauma (82.6%), endogenous (7.8%), ophthalmic surgery (6.9%), and corneal ulcer with perforation (2.7%). These four etiological groups differed in age, gender, enucleation rate, visual outcome, etc. The number of cases in the first 6 years accounted for 38.7% of the total collection, which in the second 6 years accounted for 61.3%. The etiology patterns were different between these two periods. Altogether 51.3% of patients received pars plana vitrectomy, 13.9% of patients underwent evisceration, and the remaining 34.8% received other treatments. Of the 670 cases that had culture results, 266 (39.7%) were culture positive and 177 (66.5%) were Gram-positive organisms, 64 (24.1%) were Gram-negative organisms, 11 (4.1%) had fungal infection, and 14 (5.3%) were infected by multiple pathogens.

There was an upward trend of the occurrence of infectious endophthalmitis in Western China for the past decade. The demographic and clinical characteristics of infectious endophthalmitis in Western China had its own characteristics and differed from those of developed countries. Here, open globe trauma was the most common cause of endophthalmitis, most traumatic endophthalmitis patients were male, and most of the injuries were work related, implicate that we should strengthen the education and application of ocular safety regulation specifically targeting the workplace.

One of the main aims of the updated Prostate Imaging Reporting and Data System Version 2 (PI-RADS v2) is to diminish variation in the interpretation and reporting of prostate imaging, especially among readers with varied experience levels. This study aimed to retrospectively analyze diagnostic consistency and accuracy for prostate disease among six radiologists with different experience levels from a single center and to evaluate the diagnostic performance of PI-RADS v2 scores in the detection of clinically significant prostate cancer (PCa).

From December 2014 to March 2016, 84 PCa patients and 99 benign prostatic shyperplasia patients who underwent 3.0T multiparametric magnetic resonance imaging before biopsy were included in our study. All patients received evaluation according to the PI-RADS v2 scale (1–5 scores) from six blinded readers (with 6 months and 2, 3, 4, 5, or 17 years of experience, respectively, the last reader was a reviewer/contributor for the PI-RADS v2). The correlation among the readers’ scores and the Gleason score (GS) was determined with the Kendall test. Intra-/inter-observer agreement was evaluated using κ statistics, while receiver operating characteristic curve and area under the curve analyses were performed to evaluate the diagnostic performance of the scores.

Based on the PI-RADS v2, the median κ score and standard error among all possible pairs of readers were 0.506 and 0.043, respectively; the average correlation between the six readers’ scores and the GS was positive, exhibiting weak-to-moderate strength (r = 0.391, P = 0.006). The AUC values of the six radiologists were 0.883, 0.924, 0.927, 0.932, 0.929, and 0.947, respectively.

The inter-reader agreement for the PI-RADS v2 among the six readers with different experience is weak to moderate. Different experience levels affect the interpretation of MRI images.

The latissimus dorsi (LD) flap procedure remains a popular and useful breast reconstruction tool in China and Western countries, and donor site seroma formation is the main complication. This study was conducted in Chinese patients to determine whether stable cases of seromas would resolve without treatment.

A retrospective review of 45 consecutive cases of immediate breast reconstruction with LD flap from April 2012 to February 2017 was conducted. The scope of the seroma was demarcated with a marker pen, and cases that remained stable over time (i.e. the size of the seroma did not increase) were observed without treatment. The measured outcomes included the incidence of seromas, the volume and duration of postoperative wound drainage, and other demographic characteristics.

Twenty-four patients (53.3%) developed a seroma at the donor site. Of these, 21 patients (87.5%) did not require treatment, and the seroma resolved over time. The mean duration of a sustained seroma was 6.8 ± 1.4 weeks (range: 4–9 weeks).

This study observed the scope and progression of the seromas and found that seromas at the LD donor sites resolved over time without treatment.

Jejunal feeding tube allows the nutrition of critical care patients more easy and safe. However, its placement remains a challenge. This study aimed to introduce a jejunal feeding tube through an ultrasound-guided antral progressive water injection method and subsequently to examine its efficacy.

Between April 2016 and April 2017, 54 patients hospitalized in the Department of Critical Care Medicine, Peking Union Medical College Hospital, China who needed nutritional support through a jejunal feeding tube were recruited for this study. Patients who applied ultrasound-guided antral progressive water injection method were classified into the experimental group. Patients who applied conventional method were registered as control group.

No significant differences were found in age, body mass index, and Acute Physiology and Chronic Health Evaluation score, but a significant difference in operation time was found between the experimental group and the control group. Of the 24 individuals in the control group, 17 displayed clear catheter sound shadows once the tube entered the esophagus. In comparison, of the 30 individuals in the experimental group, all harbored catheter sound shadows through the esophageal gas injection method. Subsequent observation revealed that in the control group (via ultrasonographic observation), 15 individuals underwent successful antral tube entry, for a success rate of 63%. In the experimental group (via antral progressive water injection), 27 individuals underwent successful antral tube entry, for a success rate of 90%. There was a significant difference between the success rates of the two groups (χ² = 5.834, P = 0.022).

The antral progressive water injection method for the placement of a jejunal feeding tube is more effective than the traditional ultrasonic placement method.

Excess mucus production is an important pathophysiological feature of chronic inflammatory airway diseases. Effective therapies are currently lacking. The aim of the study was to evaluate the effects of curcumin (CUR) on lipopolysaccharide (LPS)-induced mucus secretion and inflammation, and explored the underlying mechanism in vivo and in vitro.

For the in vitro study, human bronchial epithelial (NCI-H292) cells were pretreated with CUR or vehicle for 30 min, and then exposed to LPS for 24 h. Next, nuclear factor erythroid 2-related factor 2 (Nrf2) was knocked down with Nrf2 small interfering RNA (siRNA) to confirm the specific role of Nrf2 in mucin regulation of CUR in NCI-H292 cells. In vivo, C57BL/6 mice were randomly assigned to three groups (n = 7 for each group): control group, LPS group, and LPS + CUR group. Mice in LPS and LPS + CUR group were injected with saline or CUR (50 mg/kg) intraperitoneally 2 h before intratracheal instillation with LPS (100 μg/ml) for 7 days. Cell lysate and lung tissue were obtained to measured Mucin 5AC (MUC5AC) and Nrf2 mRNA and protein expression by a real-time polymerase chain reaction and Western blotting. Bronchoalveolar lavage fluid (BALF) was collected to enumerate total cells and neutrophils. Histopathological changes of the lung were observed. Data were analyzed by one-way analysis of variance. Student’s t-test was used when two groups were compared.

CUR significantly decreased the expression of MUC5AC mRNA and protein in NCI-H292 cells exposed to LPS. This effect was dose dependent (2.424 ± 0.318 vs. 7.169 ± 1.785, t = 4.534, and 1.060 ± 0.197 vs. 2.340 ± 0.209, t = 7.716; both P < 0.05, respectively) and accompanied by increased mRNA and protein expression of Nrf2 (1.952 ± 0.340 vs. 1.142 ± 0.176, t = −3.661, and 2.010 ± 0.209 vs. 1.089 ± 0.132, t = −6.453; both P < 0.05, respectively). Furthermore, knockdown of Nrf2 with siRNA increased MUC5AC mRNA expression by 47.7%, compared with levels observed in the siRNA-negative group (6.845 ± 1.478 vs. 3.391 ± 0.517, t = −3.821, P < 0.05). Knockdown of Nrf2 with siRNA also markedly increased MUC5AC protein expression in NCI-H292 cells. CUR also significantly decreased LPS-induced mRNA and protein expression of MUC5AC in mouse lung (1.672 ± 0.721 vs. 5.961 ± 2.452, t= 2.906, and 0.480 ± 0.191 vs. 2.290 ± 0.834, t = 3.665, respectively; both P < 0.05). Alcian blue/periodic acid-Schiff staining also showed that CUR suppressed mucin production. Compared with the LPS group, the numbers of inflammatory cells (247 ± 30 vs. 334 ± 24, t = 3.901, P < 0.05) and neutrophils (185 ± 22 vs. 246 ± 20, t = 3.566, P < 0.05) in BALF decreased in the LPS + CUR group, as well as reduced inflammatory cell infiltration in lung tissue.

CUR inhibits LPS-induced airway mucus hypersecretion and inflammation through activation of Nrf2 possibly.

In the current society, infertility related to age has become a social problem. The in vitro fertilization (IVF) success rate in women with poor ovarian response (POR) is very low. Dandelion extract T-1 (DE-T1) is an effective component of the extract from the leaves and stems of Taraxacum officinale, which is one of the medicines used in some patients with POR, but its molecular mechanism remains unclear.

Following IVF, ovarian granulosa cells (GCs) of sixty patients were extracted and divided into normal ovarian response (NOR) and POR groups. GCs were cultured in a dose-dependent and time-dependent manner with DE-T1, proliferation of GCs was determined by Cell Counting Kit-8 assay, and mRNA levels of insulin-like growth factor 1 receptor (IGF-1R), luteotropic hormone receptor (LHR), follicle-stimulating hormone receptor (FSHR), LHR, and CYP19A1 (aromatase) were determined by quantitative polymerase chain reaction. Progesterone and estradiol (E2) concentrations were determined by enzyme-linked immunosorbent assay.

The cell viability gradually increased with the progressive increase in the DE-T1 concentration. Compared with the control group (without DE-T1), the mRNA expressions of FSHR, LHR, IGF-1R, and CYP19A1 were upregulated after the addition of DE-T1, especially in the 2.5% DE-T1 group (P < 0.01). The expression of IGF-1R was upregulated approximately 25 times (24.97 ± 4.02 times) in the POR group with 2.5% DE-T1. E2 and progesterone levels increased with the increasing DE-T1 concentration. There were highly significant differences in the E2 and progesterone secretion between the NOR and POR groups (P < 0.01).

DE-T1 may promote steroid hormone synthesis by promoting GC proliferation and upregulating GC receptor expression, thereby improving ovarian endocrine function.

Ischemia preconditioning (IPC) remains the most powerful intervention of protection against myocardial ischemia/reperfusion injury (IRI), but diabetes can weaken or eliminate its cardioprotective effect and detailed mechanisms remain unclear. In this study, we aimed to explore whether changes of autophagy in the diabetic condition are attributable to the decreased cardioprotective effect of IPC.

Sixty diabetic male Sprague-Dawley rats were randomly divided into the control (C), IRI, rapamycin (R), wortmannin (W), rapamycin + IPC (R + IPC), and wortmannin + IPC (W + IPC) groups. The in vivo rat model of myocardial IRI was established by ligaturing and opening the left anterior descending coronary artery via the left thoracotomy. Durations of ischemia and reperfusion are 30 min and 120 min, respectively. Blood samples were taken at 120 min of reperfusion for measuring serum concentrations of troponin I (TnI) and creatine kinase isoenzyme MB (CK-MB) using the enzyme-linked immunosorbent assay. The infarct size was assessed by Evans blue and triphenyltetrazolium chloride staining. The expressions of LC3-II, beclin-1, phosphoinositide 3-kinase (PI3K), mammalian target of rapamycin (mTOR), and P-Akt/Akt ratio in the ischemic myocardium were assessed by Western blotting.

Compared to the IRI group, infarct size (56.1% ± 6.1% vs. 75.4 ± 7.1%, P < 0.05), serum cTnI (0.61 ± 0.21 vs. 0.95 ± 0.26 ng/ml, P < 0.05), and CK-MB levels (6.70 ± 1.25 vs. 11.51 ± 2.35 ng/ml, P < 0.05) obviously decreased in the W + IPC group. Compared with the C group, myocardial expressions of LC3-II (0.46 ± 0.04 and 0.56 ± 0.04 vs. 0.36 ± 0.04, P < 0.05) and beclin-1 (0.34 ± 0.08 and 0.38 ± 0.07 vs. 0.24 ± 0.03, P < 0.05) evidently increased, and myocardial expressions of mTOR (0.26 ± 0.08 and 0.25 ± 0.07 vs. 0.38 ± 0.06, P < 0.05), PI3K (0.29 ± 0.04 and 0.30 ± 0.03 vs. 0.38 ± 0.02, P < 0.05), and P-Akt/Akt ratio (0.49 ± 0.10 and 0.48 ± 0.06 vs. 0.72 ± 0.07, P < 0.05) markedly decreased in the IRI and R groups, indicating an increased autophagy. Compared with the IRI group, myocardial expression of beclin-1 (0.26 ± 0.03 vs. 0.34 ± 0.08, P < 0.05) significantly decreased, and myocardial expressions of mTOR (0.36 ± 0.04 vs. 0.26 ± 0.08, P < 0.05), PI3K (0.37 ± 0.03 vs. 0.29 ± 0.04, P < 0.05), and P-Akt/Akt ratio (0.68 ± 0.05 vs. 0.49 ± 0.10, P < 0.05) increased obviously in the W + IPC group, indicating a decreased autophagy.

Increased autophagy in the diabetic myocardium is attributable to decreased cardioprotection of IPC, and autophagy inhibited by activating the PI3K-Akt-mTOR signaling pathway can result in an improved protection of IPC against diabetic myocardial IRI.

In most countries, nearly 6% of the adults are suffering from chronic obstructive pulmonary disease (COPD), which puts a huge economic burden on the society. Moreover, COPD has been considered as an independent risk factor for pulmonary embolism (PE). In this review, we summarized the existing evidence that demonstrates the associations between COPD exacerbation and PE from various aspects, including epidemiology, pathophysiological changes, risk factors, clinical features, management, and prognosis.

We searched the terms "chronic obstructive pulmonary disease," "pulmonary embolism," "exacerbations," and "thromboembolic" in PubMed database and collected the results up to April 2018. The language was limited to English.

We thoroughly examined the titles and abstracts of all studies that met our search strategy. The data from prospective studies, meta-analyses, retrospective studies, and recent reviews were selected for preparing this review.

The prevalence of PE in patients with COPD exacerbation varied a lot among different studies, mainly due to the variations in race, sample size, study design, research setting, and enrollment criteria. Overall, whites and African Americans showed significantly higher prevalence of PE than Asian people, and the hospitalized patients showed higher prevalence of PE compared to those who were evaluated in emergency department. PE is easily overlooked in patients with COPD exacerbation due to the similar clinical symptoms. However, several factors have been identified to contribute to the increased risk of PE during COPD exacerbation. Obesity and lower limb asymmetry were described as independent predictors for PE. Moreover, due to the high risk of PE, thromboprophylaxis has been used as an important treatment for hospitalized patients with COPD exacerbation.

According to the previous studies, COPD patients with PE experienced an increased risk of death and prolonged length of hospital stay. Therefore, the thromboembolic risk in patients with acute exacerbation of COPD, especially in the hospitalized patients, should carefully be evaluated.

Varieties of critical scenarios, such as hypotension, hypoxemia, dyspnea, cardiac arrest, and acute kidney injury (AKI), which affect multiple organs, are always encountered in critically ill patients. Recently, with the noninvasive, convenient, and unique value of quick diagnosis and dynamic monitoring during the course of treatment, critical ultrasonography has been widely used in critical care medicine, which makes the bedside and real-time evaluation practical.^[1]As an important part of critical ultrasonography, critical care echocardiography (CCE) can provide information about the circulatory system from two aspects of morphology and function, which can be an effective tool to save lives in critically ill patients with hemodynamic instability. CCE can quickly identify potential causes of shock and provide definitive information to physicians to choose the correct treatment strategy.^[2,3,4,5]Therefore, CCE has become a milestone in the hemodynamic monitoring of critically ill patients. In this article, we summarize the following ten principles of CCE, which may be helpful in clinical applications.

To the Editor: In the literature, there are few reports about unilateral isolated basal vein thrombosis. Owleret al.^[1]reported the first case with imaging evidence in 2004.

To the Editor: A 32-year-old Chinese woman, complained diplopia, exophthalmos, and upper-right orbital pain and was admitted into the hospital in July 2009. Computerized tomography (CT) scan showed an upper-right orbital mass, measured 25 mm × 14 mm [Figure 1a]. Extensive surgical resection of the tumor was done on January 14, 2010. The histology confirmed the tumor was lacrimal gland adenoid cystic carcinoma (LGACC) [Figure 1b]; tumor cells infiltrated into the orbital soft tissue but were free of the orbital bone. Three-dimensional conformal external beam irradiation on the upper-right orbital area was implemented at 2 weeks after surgery with the total dose of 66GY/33F. The patient was scheduled to follow-up periodically after irradiation.

To the Editor: In the previous two decades, increasing numbers of studies have used magnetic resonance imaging (MRI) techniques to investigate the brain characteristics of schizophrenia. These studies have produced important and useful achievements and enhanced our understanding of the mechanisms of schizophrenia from neural perspectives. We hope that in the future, researchers will discover additional milestone findings in this field to relieve the current bottleneck with respect to accurately determining the mechanisms of schizophrenia and identifying precise treatment targets for this disease, which is associated with high disability and mortality.

To the Editor: Colonoscopy is currently the most commonly used method for the examination and treatment of intestinal diseases. High-quality bowel preparation is a prerequisite for colonoscopy and usually results in successful colonoscopy regarding diagnostic accuracy, procedural safety, and cost-effectiveness. At present, 9–67% of bowel preparations do not meet colonoscopy standards. Because most of the doctors or nurses in our country have a heavy workload and thus insufficient time to fully explain the details of bowel preparation to the patients, many patients are only told how to obtain bowel preparation medications along with basic bowel preparation instructions or are given a brochure about standard bowel preparation when they make their endoscopic examination appointment.^[1]However, many patients are not able to prepare appropriately without fully understanding the bowel preparation details, and hence, the quality of bowel preparation is often low. In the past few years, WeChat (Weixin in Chinese version, Tencent Ltd., China) has become one of the most popular messaging software applications (apps) on cell phones. The WeChat public number has a multifunctional background interface, allowing service providers to communicate via texts, deliver multimedia content, and chat online with all subscribers. As a representative of modern messaging software, WeChat naturally has the potential to link patients with their health providers.^[2]Here, we have performed a prospective, randomized controlled study to compare the quality of bowel preparation for colonoscopy in patients receiving standard education as compared to those using the WeChat public number for bowel preparation education. We tested the hypothesis that the WeChat public number could enhance the quality of colonoscopy by improving the adequacy of bowel preparation.

To the Editor: Primary non-Hodgkin’s lymphoma of bone (PNHLB) accounts for <5% of all primary bone tumors and <1% of all non-Hodgkin’s lymphoma.^[1]Only very few cases of PNHLB with a rapid progress have been reported in literature, thus there is still short of imaging proof. Herein, we report a rapid progressing case of PNHLB with the presentation of the clinical, radiological, and histological features of the patient.

To the Editor: Acute pancreatitis (AP) is a common digestive disorder with a broad spectrum of etiologies.^[1]Apart from gallstones and alcohol abuse which are two of most common etiologies of AP, all of other potential causes need to be considered. Pancreatectomy is the surgical removal of all or part of the pancreas, which includes pancreaticoduodenectomy (PD), distal pancreatectomy, segmental pancreatectomy, and total pancreatectomy. These procedures are used in the management of several diseases involving the pancreas, ampulla, extrahepatic bile duct, and duodenum. Based on the previous researches and studies, it was well accepted that pancreatectomy is associated with a series of common complications such as pancreatic fistula, postsurgical hemorrhage, and delayed gastric emptying.^[2]As a less frequent immediate surgical complication, postoperative AP occasionally appears just after the surgery on the pancreas. The mechanism involves direct trauma to the pancreatic parenchyma caused by pancreatectomy. To date, there has been little work on AP as a long-term complication following any pancreatectomy procedure.

To the Editor: An 84-year-old male was referred from a local clinic for an incidental thoracoabdominal aortic aneurysm (TAAA) presenting in a supraceliac aortic aneurysm (SCAA) with maximal diameter of 6.0 cm in spine magnetic resonance imaging. He had a medical history of hypertension and chronic obstructive pulmonary disease, and was a 30 pack-years' smoker. On physical examination, his vital signs were stable and abdomen was soft without pain and tenderness. Laboratory findings showed white blood cell count of 4840/µl, serum creatinine of 9 mg/L, erythrocyte sedimentation rate of 16 mm/h, and c-reactive protein of 13.24 mg/L. There was no growth of any microorganism in blood culture. Both tuberculosis polymerase chain reaction and serum acid-fast bacillus tests were negative. Pulmonary function test showed moderate obstructive lung disease. Computed tomography angiography (CTA) of aorta showed a saccular SCAA with maximal diameter of 6.0 cm, which arose from the posterior aspect of celiac axis level of aorta and enlarged posteriorly [Figure 1a]. The distance between the opening of SCAA and root of superior mesenteric artery (SMA) was 1.5 cm. Hence, we decided to perform a hybrid procedure with aorto-celiac axis bypass with thoracic endovascular aortic repair under general anesthesia [Figure 1b-1d]. We performed a cerebrospinal fluid (CSF) drainage perioperatively. Moreover, we performed peri-aortic dissection and peri-celiac axis dissection through a midline skin incision. After that, peri-aortic tunneling with a prosthetic graft (ring-reinforced polytetrafluoroethylene [PTFE] with diameter of 0.6 cm) through retropancreatic and retrorenal space was performed. And, a distal end of the graft was anastomosed to infrarenal aorta with Prolene #5-0 (Ethicon, Cincinnati, OH, USA) by end-to-side method, and a proximal end of the graft was anastomosed to celiac axis with CV #7-0 (Gore and Associates, Flagstaff, AZ, USA) by end-to-side method [Figure 1b]. After that, we exposed left femoral artery and inserted 6-Fr sheath through puncturing it. We inserted a guidewire (0.035 Glidewire^®; Terumo Medical Corporation, Somerset, NJ, USA) and an angiocatheter (5-Fr pigtail; Cook Inc., Bloomington, IN, USA) into the aorta, and confirmed the opening of SCAA, root of SMA, and patent graft through an aortography [Figure 1c]. After that, we deployed a stent-graft (2.8 cm in diameter and 12.0 cm in length; Zenith TX2; Cook Inc., Bloomington, IN, USA) from above the root of SMA to thoracic aorta through a stiff wire (Lunderquist^®; Cook Inc., Bloomington, IN, USA;Figure 1d). And, we checked patent PTFE and stent-graft without endoleak by aortography [Figure 1d]. At one week postoperatively, CTA showed type II endoleak. Moreover, the patient had no symptom. However, at six weeks postoperatively, CTA showed persistent and mild increased type II endoleak [Figure 1e]. Hence, we performed coil embolization (Interlock, Boston Scientific, Natick, MA, USA) in the root of celiac axis through PTFE graft [Figure 1f]. After that, endoleak was improved and the patient was uneventful.

To the Editor: Percutaneous nephrolithotomy (PCNL) is first-line therapy for "staghorn" stones. A multi-access approach is the mainstay of treatment in many cases because the stone burden is high. Finding feasible parameters to predict the outcome of treatment for staghorn stones is important. The factors that can affect PCNL are controversial. Several parameters, such as the infundibular-pelvic angle (IPA), upper-lower calyx angle (ULCA), infundibular length (IL), and infundibular width (IW) were important to affect the result of the operation. Whether the objective parameters in computed tomography (CT) can predict success through a particular approach has not been evaluated. This study investigated if the anatomy of the collecting system could improve the outcome in selected patients according to pretreatment images.

To the Editor: Syphilis is primarily a sexually transmitted disease caused byTreponema pallidum, which can be present in various body fluids such as blood, saliva, sperm, cerebrospinal fluid, and also in active skin lesions.^[1]Acquired syphilis contracted by Children is highly attributed to sexual abuse; however, infection can also occur by nonsexual contact; for example, prechewing feeding, kissing, fondling, or by contaminated utensils, particularly when family members or caregivers have active syphilis.^[2,3]

To the Editor: In 1983, a new prospective case-based reimbursement system called diagnosis-related groups (DRGs) emerged in the United States. Since then, this payment system has been widely applied by other developed countries, such as Australia, Germany, France, Finland, and Japan, in the form of a well-functioning DRG-based prospective payment system (PPS).^[1,2,3,4]Beijing’s Basic Medical Insurance (BBMI) scheme was launched in 2001, and its main task has been gradually covered all residents recorded on household register, including urban employees, rural residents, the elderly, children, and the unemployed. With the rapid coverage expansion of the insured crowd, the increasing rate of medical expenses has far exceeded the growth rate of the insurance tax, and the overall health insurance fund is in an imbalanced state. However, in 2010, "hold the card" policy was implemented for the convenience of patients’ reimbursement, which means that patients just pay a little of personal expenses, and the others are settled by the hospital and the Center of Medical Insurance Management (CMIM). From then on, the whole medical expenses of Beijing increased rapidly by the rate of 30–40% annual year, and medical fund could not afford the increasing rate seriously. As a result, since January 2011, all secondary and tertiary hospitals have been funded using a global control approach (the increasing rate <25% and 18%, respectively) according to the provisions of the BBMI document (No. 204, 2011). At the same time, six public tertiary hospitals in Beijing successively implemented the DRG-PPS, which symbolized the staring of medical payment reform in the mainland of China.

In the article titled "Genistein Improves Liver Damage in Male Mice Exposed to Morphine" , published on pages 1598-1604, Issue 13, Volume 131 ofChinese Medical Journal,^[1]the affiliation of all authors is written incorrectly as "Department of Anatomical Sciences, University of Kermanshah School of Medicine, Kermanshah, Taghbostan 6714686698, Iran" instead of "Department of Anatomical Sciences, Kermanshah University of Medical Sciences, Kermanshah 1568, Iran" .