2019年 · 第132卷第02期

Desminopathy, a hereditary myofibrillar myopathy, mainly results from the desmin gene (DES) mutations. Desminopathy involves various phenotypes, mainly including different cardiomyopathies, skeletal myopathy, and arrhythmia. Combined with genotype, it helps us precisely diagnose and treat for desminopathy.

Sanger sequencing was used to characterize DES variation, and then a minigene assay was used to verify the effect of splice-site mutation on pre-mRNA splicing. Phenotypes were analyzed based on clinical characteristics associated with desminopathy.

A splicing mutation (c.735+1G>T) in DES was detected in the proband. A minigene assay revealed skipping of the whole exon 3 and transcription of abnormal pre-mRNA lacking 32 codons. Another affected family member who carried the identical mutation, was identified with a novel phenotype of desminopathy, non-compaction of ventricular myocardium. There were 2 different phenotypes varied in cardiomyopathy and skeletal myopathy among the 2 patients, but no significant correlation between genotype and phenotype was identified.

We reported a novel phenotype with a splicing mutation in DES, enlarging the spectrum of phenotype in desminopathy. Molecular studies of desminopathy should promote our understanding of its pathogenesis and provide a precise molecular diagnosis of this disorder, facilitating clinical prevention and treatment at an early stage.

Irritable bowel syndrome (IBS) is one of the most common functional intestinal diseases, but its pathogenesis is still unknown. The present study aimed to screen the differentially expressed proteins in the mucosa of colon between IBS with diarrhea (IBS-D) patients and the healthy controls.

Forty-two IBS-D patients meeting the Rome III diagnostic criteria and 40 control subjects from July 2007 to June 2009 in Chinese PLA General Hospital were enrolled in the present study. We examined the protein expression profiles in mucosa of colon corresponding to IBS-D patients (n= 5) and controls (n= 5) using 2-dimensional gel electrophoresis (2-DE) and mass spectrometry (MS). Secondly, Western blot and immunohistochemical analysis were carried out to validate the screened proteins in 27 IBS-D patients and 27 controls. Thirdly, high-performance liquid chromatography (HPLC) was further carried out to determine ATP concentration in the mucosa of colon between 10 IBS-D patients and 8 controls. Comparisons between 2 groups were performed by Student’s t-test or Mann-Whitney U-test.

Twelve differentially expressed proteins were screened out. The α-enolase (ENOA) in the sigmoid colon (0.917 ± 0.007 vs. 1.310 ± 0.100, t= 2.643, P= 0.017) and caecum (0.765 ± 0.060 vs. 1.212 ± 0.122, t= 2.225, P= 0.023), Isobutyryl-CoA dehydrogenase (ACAD8) in the sigmoid colon (1.127 ± 0.201 vs. 1.497 ± 0.392, t= 7.093, P= 0.008) of the IBS-D group were significantly lower while acetyl-CoA acetyltransferase (CT) in the caecum (2.453 ± 0.422 vs. 0.931 ± 0.652, t= 8.363, P= 0.015) and ATP synthase subunit d (ATP5H) in the sigmoid (0.843 ± 0.042 vs. 0.631 ± 0.042, t= 8.613,P= 0.007) of the IBS-D group was significantly higher, compared with the controls. The ATP concentration in the mucosa of the sigmoid colon in IBS-D group was significantly lower than that of control group (0.470 [0.180, 1.360] vs. 5.350 [2.230, 7.900], U= 55, P < 0.001).

Many proteins related to energy metabolism presented differential expression patterns in the mucosa of colon of the IBS-D patients. The abnormalities in energy metabolism may be involved in the pathogenesis of IBS which deserves more studies to elucidate.

Osteogenesis imperfecta (OI), a heritable bone fragility disorder, is mainly caused by mutations in COL1A1 gene encoding α1 chain of type I collagen. This study aimed to investigate the COL1A1 mutation spectrum and quantitatively assess the genotype-phenotype relationship in a large cohort of Chinese patients with OI.

A total of 161 patients who were diagnosed as OI in Department of Endocrinology of Peking Union Medical College Hospital from January 2010 to December 2017 were included in the study. The COL1A1 mutation spectrum was identified by next generation sequencing and confirmed by Sanger sequencing. A new clinical scoring system was developed to quantitatively assess the clinical severity of OI and the genotype-phenotype relationship was analyzed. The independent sample t-test, analysis of variance, Mann-Whitney U-test, Chi-squared test, Pearson correlation, and multiple linear regression were applied for statistical analyses.

Among 161 patients with OI, 32.9% missense mutations, 16.8% non-sense mutations, 24.2% splice-site mutations, 24.8% frameshift mutations, and 1.2% whole-gene deletions were identified, of which 38 variations were novel. These mutations led to 53 patients carrying qualitative defects and 67 patients carrying quantitative defects in type I collagen. Compared to patients with quantitative mutations, patients with qualitative mutations had lower alkaline phosphatase level (296 [132, 346] U/L vs. 218 [136, 284] U/L, P= 0.009) and higher clinical score (12.2 ± 5.3 vs. 7.4 ± 2.4, P < 0.001), denoting more severe phenotypes including shorter stature, lower bone mineral density, higher fracture frequency, more bone deformity, vertebral compressive fractures, limited movement, and dentinogenesis imperfecta (DI). Patients would not present with DI if the glycine substitutions happened before the 79th amino acid in triple helix of α1 chains .

This presented distinctive COL1A1 mutation spectrum in a large cohort of Chinese patients with OI. This new quantitative analysis of genotype-phenotype correlation would be helpful to predict the prognosis of OI and genetic counseling.

Weight gain during pregnancy reflects the mother’s nutritional status. However, it may be affected by nutritional therapy and exercise interventions used to control blood sugar in gestational diabetes mellitus (GDM). This study aimed to evaluate weight gain during gestation and pregnancy outcomes among women with GDM.

A retrospective study involving 1523 women with GDM was conducted between July 2013 and July 2016. Demographic data, gestational weight gain (GWG), blood glucose, glycated-hemoglobin level, and maternal and fetal outcomes were extracted from medical records. Relationships between GWG and pregnancy outcomes were investigated using multivariate logistic regression.

In total, 451 (29.6%) women showed insufficient GWG and 484 (31.8%) showed excessive GWG. Excessive GWG was independently associated with macrosomia (adjusted odds ratio [aOR] 2.20, 95% confidence interval [CI] 1.50–3.52, P < 0.001), large for gestational age (aOR 2.06, 95% CI 1.44–2.93, P < 0.001), small for gestational age (aOR 0.49, 95% CI 0.25–0.97, P= 0.040), neonatal hypoglycemia (aOR 3.80, 95% CI 1.20–12.00, P= 0.023), preterm birth (aOR 0.45, 95% CI 0.21–0.96, P= 0.040), and cesarean delivery (aOR 1.45, 95% CI 1.13–1.87, P= 0.004). Insufficient GWG increased the incidence of preterm birth (aOR 3.53, 95% CI 1.96–6.37, P < 0.001).

Both excessive and insufficient weight gain require attention in women with GDM. Nutritional therapy and exercise interventions to control blood glucose should also be used to control reasonable weight gain during pregnancy to decrease adverse pregnancy outcomes.

DNA methylation is involved in numerous biologic events and associates with transcriptional gene silencing, playing an important role in the pathogenesis of endometrial cancer. ESR1/PGR frequently undergoes de novo methylation and loss expression in a wide variety of tumors, including breast, colon, lung, and brain tumors. However, the mechanisms underlying estrogen and progesterone receptors (ER/PR) loss in endometrial cancer have not been studied extensively. The aims of this study were to determine the expression of DNA (cytosine-5)-methyltransferase 3A/3B (DNMT3A/3B) in endometrial cancer to investigate whether the methylation catalyzed by DNMT3A/3B contributes to low ER/PR expression.

The clinicopathologic information and RNA-Seq expression data of DNMT3A/3B of 544 endometrial cancers were derived from The Cancer Genome Atlas (TCGA) uterine cancer cohort in May 2018. RNA-Seq level of DNMT3A/3B was compared between these clinicopathologic factors with t-test or one-way analysis of variance.

DNMT3A/3B was overexpressed in endometrioid carcinoma (EEC) and was even higher in non-endometrioid carcinoma (NEEC) (DNMT3A, EEC vs. NEEC: 37.6% vs. 69.9%, t=－7.440, P < 0.001; DNMT3B, EEC vs. NEEC: 42.4% vs. 72.8 %, t= －6.897, P < 0.001). In EEC, DNMT3A overexpression was significantly correlated with the hypermethylation and low expression of the ESR1 and PGR (P < 0.05). The same trend was observed in the DNMT3B overexpression subgroup. In the ESR1/PGR low-expression subgroups, as much as 83.1% of ESR1 and 59.5% of PGR were hypermethylated, which was significantly greater than the ESR1/PGR high-expression subgroups (31.3% and 11.9%, respectively). However, the above phenomena were absent in NEEC, while DNMT3A/3B overexpression, ESR1/PGR hypermethylation, and low ER/PR expression occurred much more often. In univariate analysis, DNMT3A/3B overexpressions were significantly correlated with worse prognosis. In multivariate analysis, only DNMT3A was an independent predictor of disease-free survival (P < 0.05).

DNMT3A/3B expression increases progressively from EEC to NEEC and is correlated with poor survival. The mechanisms underlying low ER/PR expression might be distinct in EEC vs. NEEC. In EEC, methylation related to DNMT3A/3B overexpression might play a major role in ER/PR downregulation.

Contributing to the innovative behavior of individuals in the health management process is a desirable condition for increased health institution performance. The relationship between the sense of loneliness and individual innovation behaviors has not been studied and relevant literature is extremely limited. The purpose of this research was to examine the effect of an individual’s sense of loneliness on their innovative behavior.

The research was performed between January and October 2018. The effects of loneliness feelings on the individual innovative behaviors of 451 health science faculty students were measured. The data were collected using the "Individual Information Form," the "individual innovation scale," and the "University of California Los Angeles loneliness scale." The reliability and validity of the scales were tested with Structural Equation Modeling.

It was found that the female participants showed exhibited more innovative behavior than the men. However, there was no significant difference in the loneliness status of participants by gender. A group of 23-year-old individuals showed a significant difference in the risk taking dimension compared to other age groups. First-grade students had more points in the experimental openness and opinion leadership sub-dimension than the other classes. It was observed that the behavior is molded as the education level increases. The regression models showed that loneliness has a negative effect of －0.254 on experiential openness and the leadership of ideas, and has a negative effect of －0.216 on risk taking. There was no effect of the sub-dimensions of loneliness on change resistance. Moreover, on the individualistic behavior of physical loneliness, a －0.267 negative effect was observed. Emotional loneliness has no effect on the sub-dimensions of individual innovation. Finally, the total sense of loneliness was found to have a negative effect on total individual innovation.

The study results clearly show that physical loneliness has a negative effect on individual innovation. It can be said that individuals living in social environments exhibit more innovative behaviors. However, emotional loneliness has no significant effect on innovative behavior. In this context, designing social spaces in health institutions will stimulate individuals’ innovative behaviors.

Vestibular migraine (VM), a common disorder with familiar predisposition, is characterized by recurrent episode of dizziness or vertigo and accompanying symptoms of nausea, vomiting, and/or headaches. The patients with VM may require neurologic, emergency, or otorhinolaryngologic services, and the disorder is often misdiagnosed with posterior circulation ischemia (PCI) or transient ischemic attack (TIA), peripheral vestibular vertigo, Meniere’s disease (MD), and multiple (lacunar) cerebral infarctions. Report from population-based study showed that the prevalence of VM was up to 1%,^[1]which was one of the common disorders causing dizziness/vertigo, and the rate of misdiagnosis was up to 80%.^[2]Thus, a multidisciplinary expert consensus about the definition, characteristics, related work-ups, and diagnostic criteria is needed for the accurate diagnosis and standardized management.

Physiologic cardiac pacing is a novel technique which has been largely popularized in recent decades. His bundle pacing (HBP) has been long considered the most physiologic pacing method; however, with the widespread implementation of this method, its disadvantages have become apparent. In this context, left bundle branch pacing (LBBP)—directly engaged in the His-Purkinje system—has been foreseen as the best pacing method to mimic physiologic activation patterns. This review aimed to summarize recent approaches to physiologic cardiac pacing.

This review included fully peer reviewed publications up to July 2018, found in the PubMed database using the keywords "His bundle branch pacing," "right ventricular pacing," and "physiologic pacing."

All selected articles were in English, with no restriction on study design.

The HBP has been studied worldwide, and is currently considered the most physiologic pacing method. However, it has disadvantages, such as high pacing threshold, unsatisfactory sensing and long procedure times, among others. Although LBBP is theoretically superior to HBP, the clinical relevance of this difference remains under debate, as few large randomized clinical trials with LBBP have been published.

Although HBP indeed appears to be the most physiologic pacing method, it has certain shortcomings, such as high pacing threshold, difficult implantation due to specific anatomic features, and others. Further studies are required to clarify the clinical significance of LBBP.

Dual antiplatelet therapy (DAPT) with aspirin and a P2Y₁₂ receptor inhibitor is the cornerstone of treatment in patients with acute coronary syndromes (ACS) and in those undergoing percutaneous coronary intervention (PCI). In current clinical situation, availability of different oral P2Y₁₂ inhibitors (clopidogrel, prasugrel, and ticagrelor) has enabled physicians to switch among therapies owing to specific clinical scenarios. Although optimum time, loading dose and interval of transition between P2Y₁2 inhibitors is still controversial and needs further evidence, switching between oral inhibitors frequently occurs in clinical practice for several reasons.

This review was based on data in articles published in PubMed up to June 2018, with the following keywords "antiplatelet therapy" , "ACS" , "PCI" , "ticagrelor" and "clopidogrel" .

Original articles and critical reviews on de-escalation strategy in ACS patients after PCI were selected. References of the retrieved articles were also screened to search for potentially relevant papers.

Safety concerns associated with switching between antiplatelet agents, has prompted the use of clopidogrel for patients with ACS especially after PCI as a de-escalation strategy. Practical considerations for de-escalating therapies in patients with ACS such as reducing dose of P2Y₁₂ inhibitors or shortening duration of DAPT (followed by aspirin or P2Y₁₂ receptor inhibitor monotherapy) as potential options are yet to be standardized and validated.

Current review will provide an overview of the pharmacology of common P2Y₁₂ inhibitors, definitions of deescalation and different de-escalating strategies and its outcomes, along with possible direction to be explored in de-escalation.

To review the literature regarding diagnosis and treatment of labral tear.

A systematic search was performed in PubMed using various search terms and their combinations including hip, labrum, acetabular labral tear, arthroscopy, diagnosis, and anatomy.

For each included study, information regarding anatomy, function, etiology, diagnosis, and management of acetabular labral tear was extracted.

Five hundred and sixty abstracts about anatomy, function, etiology, diagnosis, and management of acetabular labral tear were reviewed and 66 selected for full-text review. The mechanism of labral tear has been well explained while the long-term outcomes of various treatment remains unknown.

Labral tear is generally secondary to femoroacetabular impingement, trauma, dysplasia, capsular laxity, and degeneration. Patients with labral tear complain about anterior hip or groin pain most commonly with a most consistent physical examination called positive anterior hip impingement test. Magnetic resonance arthrography is a reliable radiographic examination with arthroscopy being the gold standard. Conservative treatment consists of rest, non-steroidal anti-inflammatory medication, pain medications, modification of activities, physical therapy, and intra-articular injection. When fail to respond to conservative treatment, surgical treatment including labral debridement, labral repair, and labral reconstruction is often indicated.

To the Editor:A 53-year-old man recently presented to our hospital with a history of palpitations, lightheadedness, dyspnea and chest tightness over the past half month. In addition, the patient had been prone to activity-induced fatigue since childhood, and had a history of being susceptible to respiratory tract infection. Following physical examination, there was a detected an irregular pulse and cardiac murmur. Auscultation of the pulmonary valve revealed accentuation of the second heart sound at the left side of the sternum, between the first and second ribs, and grade 3/6 systolic murmur. Basic laboratory investigations were unremarkable. Electrocardiogram (ECG) showed atrial fibrillation (AF). Chest radiograph showed mild cardiomegaly. Transthoracic echocardiogram (TTE) was suggestive of atrial septal defect (ASD) from left to right shunt; dilated left atrium, right atrium and right ventricle; moderate tricuspid regurgitation; mild pulmonary arterial hypertension and a markedly dilated coronary sinus due to persistent left superior vena cava (PLSVC). Cardiac computed tomography (CT) was considered for better delineation of the venous anomaly and to define the location of the shunt. CT was performed on a Philips Brilliance 64 slice multidetector CT (MDCT) scanner, which confirmed the TTE findings of PLSVC [Figure 1A], and defined the cardiac shunt as sinus venosus-type atrial septal defect (SVASD) [Figure 1B]. The opening of right superior vena cava (SVC) drains into the roof of left atrium [Figure 1B]. Left-sided persistent SVC was seen draining into the coronary sinus which then was grossly dilated, measuring at 3.0 cm. A defect measuring 2.0 cm was seen in the inter-atrial septum. Moreover, CT helped to rule out some cardiac anomalies more commonly reported in association with PLSVC such as ventricular septal defect, aortic coarctation, transposition of the great vessels, Tetralogy of Fallot, and anomalous connections of the pulmonary veins. SVASD, if left unrepaired, may eventually lead to right-heart volume overload and subsequent hypertensive pulmonary vascular disease. The PLSVC drains into the right atrium via the coronary sinus, resulting in no hemodynamic consequence. However, when the right SVC drains directly into the roof of left atrium, it may result in right-to-left shunt or hemodynamic overload on the left atrium with the risk of atrial fibrillation or paradoxical embolization. Therefore, the patient was advised to undergo surgery. The cardiac surgery involved opening the right heart chamber and requiring drainage of the PLSVC by a separate venous cannula. The modified Cox-Maze AF surgical procedure is concomitant with the SVASD repair. The surgical patch is used to repair SVASD and isolate the opening of right SVC to the right atrium. We did not ligate the PLSVC.

To the Editor:According to World Health Organization (WHO) histologic classification of lung tumors, primary pulmonary lymphoepithelioma-like carcinoma (LELC), belonging to the other and unclassified carcinoma, is considered as a rare subtype of variants of lung cancer.^[1,2]The first case of pulmonary LELC was reported in 1987. Many studies showed a close relationship between Epstein-Barr virus (EBV) infection and pulmonary LELC.^[1,3]Then, it has been found that the incidence in the Asian population was significantly higher than that in the Western population.^[1]Situs inversus totalis (SIT) is a rare autosomal recessive condition in which the organs in the chest and abdomen are positioned in a mirror image from their normal location to the other side of the body. Some investigations demonstrated that the incidence of SIT is approximately 1/5000 to 1/10,000 in live births.^[4,5]Here, we report a rare case of primary pulmonary LELC combined with SIT.

To the Editor:The differentiation of multiple primary lung adenocarcinomas (MPLAs) from metastases is important to allow for proper clinical management and prognostic prediction. The current revised diagnostic criteria for MPLAs proposed by the American College of Chest Physicians (ACCP) have been commonly applied since 2003.^[1]However, it remains technically challenging to determine whether 2 or more lung adenocarcinomas from the same patient are homologous. Various approaches and algorithms including gene mutation analysis addressing this problem have been described.^[2,3]Here, we present a cohort of 45 patients with synchronous multifocal lung adenocarcinomas.

To the Editor:Serum alkaline phosphatase (ALP) is an important bone turnover marker in chronic kidney disease (CKD) patients, with studies indicating that higher serum ALP levels are associated with increased mortality in hemodialysis (HD) patients.^[1]Our previous study also showed that higher serum ALP levels were independently associated with all-cause and cardiovascular mortality in peritoneal dialysis (PD) patients.^[2]Recently, a report from Taiwan (China) revealed that ALP concentrations were not associated with mortality in PD patients over a 5-year period.^[3]The outcome-predictability using ALP in PD patients, therefore, remains uncertain, and the relationship between serum ALP and all-cause mortality in different ages remains unclear. Here, we investigated the relationship of serum ALP with all-cause mortality in younger and elderly PD patients.

To the Editor:Lipoprotein glomerulopathy (LPG) is an uncommon inherited renal disease characterized by lipoprotein thrombi in the markedly dilated capillary lumina of affected glomeruli, high plasma concentrations of apolipoprotein E (apoE), and proteinuria.^[1]It mainly affects people of Japanese and Chinese origin, and approximately 117 cases have been reported to date.^[2,3]Several genetic studies have demonstrated thatAPOEgene mutations may lead to the development of LPG;^[4,5,6]however, conflicting published evidence has found that some patients withAPOEvariants were unaffected.^[7]Thus, further studies are needed to examine the role ofAPOEmutations in the pathogenesis of LPG. This study investigated a novel point mutation in theAPOEgene in a family with one LPG patient and an asymptomatic carrier of the sameAPOEvariant.

To the Editor:The co-existence of primary hyperparathyroidism (pHPT) and nonmedullary thyroid carcinoma (NMTC) has been reported occasionally since 1956;^[1,2]meanwhile, the synchronous occurrence of pHPT and two distinct tumors (follicular and papillary thyroid carcinoma) has rarely been reported. Here, we report the case of a 66-year-old female patient who was transferred to a surgery specialist with the complaints of pHPT and two distinct carcinomas. The patient was admitted to the Department of Endocrinology and Metabolism in our hospital on May 21, 2018 because of an elevation of serum calcium level at 2.80 mmol/L (reference range 2.08–2.60 mmol/L). Laboratory examinations revealed that the parathyroid hormone (PTH) level was 111.4 ng/L (reference range 15–65 ng/L), which suggested the diagnosis of pHPT. However, the patient had no symptoms suggestive of hypercalcemia such as generalized weakness or nausea. Subsequent single-photon emission computed tomography (SPECT) in combination with computed tomography (CT) was performed. Both early-and late-phase images showed enhanced focal retention of Tc–99m MIBI located at the middle-upper part of the right thyroid lobe, and the abnormal signal accumulation was localized specifically at the middle-upper part of the dorsal right thyroid lobe by the fusion imaging of SPECT/CT, which suggested the existence of right-sided parathyroid adenoma [Figure 1A]. The patient provided no significant medical history and family history associated with multiple endocrine adenomatosis (MEN), and her CT scan of adrenal areas and cranial magnetic resonance imaging (MRI) scan demonstrated no obvious abnormality, therefore ruling out the possibility of MEN. Radionuclide bone imaging was also performed, and no abnormity was found. The patient then received ultrasound examination and a right-side parathyroid adenoma and bilateral solid thyroid nodules were detected [Figure 1Band1C]. Fine-needle aspiration cytology (FNAC) was performed under the guidance of ultrasound, and the pathological result indicated the co-existence of lymphocytic thyroiditis, follicular neoplasm, and epithelial papillary hyperplasia. Subsequently, the patient was transferred to the general surgery department for the surgical treatment of right parathyroidectomy and bilateral total thyroidectomy. Pathological diagnosis of the surgical specimens revealed bilateral multinodular goiter, left-sided thyroid adenoma, right-sided thyroid follicular carcinoma (with capsular microinvasion, 1.2 × 1.0 × 1.0 cm) [Figure 1D], papillary microcarcinoma (0.5 × 0.4 × 0.3 cm) [Figure 1Eand1F], and a parathyroid adenoma. Her post-operative serum calcium level decreased to 2.2 mmol/L, and the patient was discharged 4 days after surgery.

To the Editor:Living donor liver transplantation (LDLT) has expanded the donor pool in countries with low cadaveric organ donation rates. Generally, a left-side liver allograft is sufficient and safe for child and adolescent recipients.^[1]For the sake of the donor’s cosmetic demands and for early functional rehabilitation, laparoscopic technology has been used in live hepatectomy since 2002.^[2]Three-dimensional visualization provides better depth perception and tactile feedback than does conventional two-dimensional laparoscopy.^[3]In this report, we presented a case of pure three-dimensional laparoscopic full left live hepatectomy.

To the Editor: A 49-year-old woman with a 15-year history of splenectomy due to accident trauma presented with asymptomatic small-sized masses staying at the Douglas fossa in a routine obstetric examination. She was immediately admitted into Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine for further evaluation. Abdominal palpation and laboratory tests noted no particular findings. Vaginal ultrasound showed a few unconnected masses of variable size ranging from 1 cm to 4 cm, apart from the uterus. Computed tomography revealed multiple soft-tissue shadows with no enhancement [Figure 1]. Regarding her splenectomy and imaging findings, ectopic spleen autotransplantation (ESAT) was considered. Splenic tissue seeding refers to spontaneous ESAT following traumatic splenic injury or splenectomy.^[1,2,3,4,5]Some fragments can survive in all possibilities of final staying location, and more frequently seen in abdominal cavity such as pelvic peritoneum.^[1,2,4,5]The majorities of splenosis will not bring about any clinical presentations. More importantly, these seeded splenic chips can embrace partial performance of the normal spleen once they take shape (for example, protection against potential of severe infection after splenectomy); therefore, for asymptomatic patients, intervention is unnecessary.^[1,3,5]As to date, radionuclide splenic imaging (using [99m] Tc-sulfur colloid radioactivity), fine-needle biopsy, and laparoscopy exploration may be favorable for making a conclusive diagnosis. However, if these seeds lead to obvious complications such as small bowel obstruction during their growing and developing courses, or when they are difficult to differ from malignant tumors, laparoscopic surgery is indicated. In this case, if necessary, biopsy via culdocentesis will be performed for further confirming initial interpretation, but close surveillance ought to be more optimal option. Hence, she was discharged with no treatment. At 1-year follow-up, the masses kept their previous position with no change. This case suggested the bottom of pelvic peritoneum might be a potential location for spleen implants when and if lack of omentum, aiming to safely preserve partial function of spleen.

To the Editor:Adenoid cystic carcinoma (ACC) is a rare tumor, accounting for approximately 1% of all head and neck malignant neoplasms.^[1]ACC typically arises in the major and minor salivary glands. Despite poor growth, frequent local recurrence and late distant metastasis have been reported. The organs most frequently involved include the lungs, bones, brain, and liver,^[2]whereas metastasis to the thyroid is relatively rare. Herein, we reported a case of metastasis to the bilateral thyroid lobe in a 42-year-old woman with ACC of the submaxillary gland that was excised 2 years ago. The main aim of the present case was to focus on the ultrasonic and elastography features of thyroid metastasis from ACC when ultrasonography is the first means to diagnose a thyroid nodule.

To the Editor:We here reported a case of a breast lesion found by rapid pathological examination of frozen sections on February 2, 2018. The lesion was very similar to breast cancer in terms of gross observation and histological features. Immunohistochemistry and phos-phatidylinositol-3-kinase (PIK3CA) gene sequencing were performed. The clinicopathological features of the lesion were reported in detail.

In the article titled "A Randomized, Double-Blind, Multicenter, Placebo-Controlled Trial of Qi-Zhi-Wei-Tong Granules on Postprandial Distress Syndrome-Predominant Functional Dyspepsia" , published on page 1549–1556, Issue 13, Volume 131 ofChinese Medical Journal,^[1]the affiliation of authors and address for correspondence is written incorrectly as "Department of Gastroenterology, Wuhan Union Hospital of Huazhong University of Science and Technology, Wuhan, Hubei 430000, China" instead of "Department of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, China" .