2019年 · 第132卷第14期

Unprotected anal intercourse (UAI) has previously been associated with human immunodeficiency virus (HIV) infection. Male students who have sex with men (SMSM) are at increased exposure to experience UAI. The aim of this study was to investigate the status of UAI and related factors among SMSM in three northern regions of China.

From November 2018 to January 2019, SMSM, 18 years or older, studying or living in Beijing, Tianjin, or Shijiazhuang, who had anal sex in the past 6 months were recruited by community-based organizations to participate in an unmatched, casecontrol study. Detailed demographic and behavioral information were collected via self-administrated electronic questionnaires and factors related to UAI were assessed using uni- and multivariate logistic regression analyses.

Among the 511 SMSM included in the study, 210 (41.1%) reported UAI in the past 6 months. SMSM who had sexual partners at least 10 years older than themselves (odds ratio [OR] = 2.277, 95% confidence interval [CI]: 1.380–3.756), used vacant capsules before sexual activity (OR = 3.858, 95% CI: 1.472–10.106), had a self-perceived moderate-HIV risk (OR = 2.128, 95% CI: 1.403–3.227), and unprotected, first anal intercourse (OR = 2.236, 95% CI: 1.506–3.320) had increased odds of UAI.

Factors associated with increased odds of engaging in UAI in the past 6 months among SMSM included having older sexual partners, using vacant capsules, having a self-perceived moderate risk of HIV, and unprotected, first anal intercourse. Continuing education on risk reduction, including improving condom decision making in age-discordant relationships could help address the sexual risk behaviors among SMSM.

Zika virus (ZIKV) has emerged as a global pathogen causing significant public health concerns. China has reported several imported cases where ZIKV were carried by travelers who frequently travel between China and ZIKV-endemic regions. To fully characterize the ZIKV strains isolated from the cases reported in China and assess the risk of ZIKV transmission in China, comprehensive phylogenetic and genetic analyses were performed both on all ZIKV sequences of China and on a group of scientifically selected ZIKV sequences reported in some of the top interested destinations for Chinese travelers.

ZIKV genomic sequences were retrieved from the National Center for Biotechnology Information database through stratified sampling. Recombination event detection, maximum likelihood (ML) phylogenetic analysis, molecular clock analysis, selection pressure analysis, and amino acid substitution analysis were used to reconstruct the epidemiology and molecular transmission of ZIKV.

The present study investigated 18 ZIKV sequences from China and 70 sequences from 16 selected countries. Recombination events rarely happens in all ZIKV Asian lineage. ZIKV genomes were generally undergone episodic positive selection (17 sites), and only one site was under pervasive positive selection. All ZIKV imported into China were Asian lineage and were assigned into two clusters: Venezuela-origin (cluster A) and Samoa-origin cluster (cluster B) with common ancestor from French Polynesia. The time of most recent common ancestors of Cluster A dated to approximately 2013/11 (95% highest posterior density [HPD] 2013/06, 2014/03) and cluster B dated to 2014/08 (95% HPD 2014/02, 2015/01). Cluster B is more variable than Cluster A in comparison with other clusters, but no varied site of biological significance was revealed. ZIKV strains in Southeast Asia countries are independent from strains in America epidemics.

The genetic evolution of ZIKV is conservative. There are two independent introductions of ZIKV into China and China is in danger of autochthonous transmission of ZIKV because of high-risk surrounding areas. Southeast Asia areas have high risk of originating the next large-scale epidemic ZIKV strains.

The coexistence of chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) is termed overlap syndrome (OS). COPD and OSA both have increased risks of developing cardiovascular diseases. This study aimed to explore if patients with OS exhibited a higher prevalence of cardiovascular complications, and if patients with OS exhibited vascular endothelial dysfunction and abnormalities in the cellular immune function of T lymphocytes.

Totally 25 patients with stable COPD (COPD group), 25 patients with OSA (OSA group), 25 patients with OS (OS group), and 20 healthy adults (control group) were enrolled between January 2017 and December 2017 from the Respiratory Department of Tianjin Medical University General Hospital. The clinical characteristics of the four groups were collected and the expression levels of soluble vascular cell adhesion molecule-1 (sVCAM-1), tumor necrosis factor-α (TNF-α), and T-lymphocyte subsets were detected. One-way analysis of variance, χ² test and Pearson correlation were used to manage the data.

The prevalence of hypertension and coronary heart disease was significantly higher in the OS group than in the control, OSA, and COPD groups (χ² = 20.69, P < 0.05 and χ² = 11.03, P < 0.05, respectively). The levels of sVCAM-1 and TNF-α were significantly higher in the OS group than in other groups (F = 127.40, P < 0.05 and F = 846.77, P < 0.05, respectively). The percentage of CD4+ lymphocytes and CD4+/CD8+ were both significantly lower in the OS group than in any other group (F = 25.40, P < 0.05 and F = 75.08, P < 0.05, respectively). There were significantly negative correlations in the levels of sVCAM-1 and TNF-α with CD4+/CD8+ lymphocytes (r = –0.77, P < 0.05 and r = –0.83, P < 0.05, respectively).

The prevalence of hypertension and coronary heart disease was higher in patients with OS than in patients with either OSA or COPD alone. Patients with OS exhibited more severe vascular endothelial injury, stronger inflammatory response, and lower cellular immune function.

Acute kidney injury (AKI) is a serious and fatal complication of acute myocardial infarction (AMI). It has high shortand long-term mortality rates and a poor prognosis but is potentially preventable. However, the current incidence, risk factors, and outcomes of AKI in the Chinese population are not well understood and would serve the first step to identify high-risk patients who could receive preventative care.

The medical data of 1124 hospitalized patients diagnosed with AMI from October 2013 to September 2015 were reviewed. AKI was defined according to the 2012 Kidney Disease Improving Global Outcomes criteria. All the patients were divided into either the AKI group or the non-AKI group. A univariate comparison analysis was performed to identify possible risk factors associated with AKI. A multiple logistic regression analysis was used to identify the independent risk factors for AKI in patients with AMI.

Overall, the incidence of AKI was 26.0%. The mortality rate of the AKI group was 20.5%, and the mortality rate of the non-AKI group was 0.6% (P < 0.001). Logistic regression analysis showed that the independent risk factors for AKI in patients with AMI included: age (>60 years old) (odds ratio [OR] 1.04, 95% confidence interval [CI] 1.02–1.05, P = 0.000), hypertension (OR 2.51, 95% CI 1.62–3.87, P = 0.000), chronic kidney disease (OR 3.52, 95% CI 2.01–6.16, P = 0.000), Killip class ≥3 (OR 5.22, 95% CI 3.07–8.87, P = 0.000), extensive anterior myocardial infarction (OR 3.02, 95% CI 1.85–4.93, P = 0.000), use of furosemide (OR 1.02, 95% CI 1.02–1.03, P = 0.000), non-use of angiotensin-converting enzyme inhibitors/angiotensin receptor blocker (OR 1.58, 95% CI 1.04–2.40, P = 0.032). These factors provided an accurate tool to identify patients at high risk of developing AKI.

Approximately 26.0% of patients undergoing AMI developed AKI, and the development of AKI was strongly correlated with in-hospital mortality. The risk factors for AKI in patients with AMI were determined to help identify high-risk patients and make appropriate clinical decisions.

The detection of polyneuropathy, organomegaly, endocrinopathy, M-protein, and skin changes (POEMS) syndrome at early stage is challenging for neurologists. Since polyneuropathy could be the first manifestation, it could be misdiagnosed as chronic inflammatory demyelinating polyneuropathy (CIDP). The present study aimed to determine the clinical and electrophysiological features of POEMS syndrome to distinguish from CIDP.

The data of a group of patients with POEMS (n = 17) and patients with CIDP (n = 17) in Zhongshan Hospital Fudan University from January 2015 to September 2017 were analyzed in this retrospective study. The clinical features, neurological symptoms, and electrophysiological findings were compared between the two groups.

Clinically, patients with POEMS demonstrated significantly more neuropathic pain in the lower extremities than patients with CIDP (58.8% vs. 11.8%, P = 0.01). Multisystem features like edema, skin change, organomegaly, and thrombocytosis were also pointed towards the diagnosis of POEMS syndrome. Electrophysiologically, terminal latency index (TLI) was significantly higher in patients with POEMS than that in patients with CIDP (median nerve: 0.39 [0.17–0.52] vs. 0.30 (0.07–0.69), Z = –2.413, P = 0.016; ulnar nerve: 0.55 [0.23–0.78] vs. 0.42 [0.12–0.70], Z = –2.034, P = 0.042). Patients with POEMS demonstrated a higher frequency of absent compound muscle action potential of the tibial nerve (52.9% vs. 17.6%, P = 0.031), less conduction block (ulnar nerve: 0 vs. 35.3%, P = 0.018), and less temporal dispersion (median nerve: 17.6% vs. 58.8%, P = 0.032) than CIDP group. The combination of positive serum monoclonal protein and high TLI (if either one or both were present) discriminated POEMS from CIDP with a sensitivity of 94.1% and 47.1% and specificity of 76.5% and 100.0%, respectively.

POEMS syndrome could be distinguished from CIDP through typical clinical and electrophysiological characteristics in practice. The combination of serum monoclonal protein and high TLI might raise the sensitivity of detecting POEMS syndrome.

Structured reports are not widely used and thus most reports exist in the form of free text. The process of data extraction by experts is time-consuming and error-prone, whereas data extraction by natural language processing (NLP) is a potential solution that could improve diagnosis efficiency and accuracy. The purpose of this study was to evaluate an NLP program that determines American College of Radiology Breast Imaging Reporting and Data System (BI-RADS) descriptors and final assessment categories from breast magnetic resonance imaging (MRI) reports.

This cross-sectional study involved 2330 breast MRI reports in the electronic medical record from 2009 to 2017. We used 1635 reports for the creation of a revised BI-RADS MRI lexicon and synonyms lists as well as the iterative development of an NLP system. The remaining 695 reports that were not used for developing the system were used as an independent test set for the final evaluation of the NLP system. The recall and precision of an NLP algorithm to detect the revised BI-RADS MRI descriptors and BI-RADS categories from the free-text reports were evaluated against a standard reference of manual human review.

There was a high level of agreement between two manual reviewers, with a κ value of 0.95. For all breast imaging reports, the NLP algorithm demonstrated a recall of 78.5% and a precision of 86.1% for correct identification of the revised BI-RADS MRI descriptors and the BI-RADS categories. NLP generated the total results in <1 s, whereas the manual reviewers averaged 3.38 and 3.23 min per report, respectively.

The NLP algorithm demonstrates high recall and precision for information extraction from free-text reports. This approach will help to narrow the gap between unstructured report text and structured data, which is needed in decision support and other applications.

Brachydactyly, a developmental disorder, refers to shortening of hands/feet due to small or missing metacarpals/metatarsals and/or phalanges. Isolated brachydactyly type E (BDE), characterized by shortened metacarpals and/or metatarsals, consists in a small proportion of patients with Homeobox D13 (HOXD13) or parathyroid-hormone-like hormone (PTHLH) mutations. BDE is often accompanied by other anomalies that are parts of many congenital syndromes. In this study, we investigated a Chinese family presented with BDE combined with pectus carinatum and short stature.

A four-generation Chinese family was recruited in June 2016. After informed consent was obtained, venous blood was collected, and genomic DNA was extracted by standard procedures. Whole-exome sequencing was performed to screen pathogenic mutation, array comparative genomic hybridization (Array-CGH) analysis was used to analyze copy number variations, and quantitative real-time polymerase chain reaction (PCR), stride over breakpoint PCR (gap-PCR), and Sanger sequencing were performed to confirm the candidate variation.

A 3.06-Mb deletion (chr12:25473650–28536747) was identified and segregated with the phenotype in this family. The deletion region encompasses 23 annotated genes, one of which is PTHLH which has been reported to be causative to the BDE. PTHLH is an important regulator of endochondral bone development. The affected individuals showed bilateral, severe, and generalized brachydactyly with short stature, pectus carinatum, and prematurely fusion of epiphyses. The feature of pectus carinatum has not been described in the PTHLH-related BDE patients previously.

The haploinsufficiency of PTHLH might be responsible for the disease in this family. This study has expanded the knowledge on the phenotypic presentation of PTHLH variation.

Depression affects approximately 5% of elderly people and its etiology might be related to chronic stress exposure during neurodevelopmental periods. In this study, we examined the effects of adolescent chronic social stress in aged mice on depressive behaviors and the excitatory-inhibitory (E/I) balance in stress-sensitive regions of the brain.

Sixty-four adolescent, male C57BL/6 mice were randomly assigned to either the 7-week (from post-natal days 29 to 77) social instability stress (stress group, n = 32) or normal housing conditions (control group, n = 32). At 15 months of age, 16 mice were randomly selected from each group for a series of behavioral tests, including two depression-related tasks (the sucrose preference test and the tail suspension test). Three days following the last behavioral test, eight mice were randomly selected from each group for immunohistochemical analyses to measure the cell density of parvalbumin (PV⁺)- and calretinin (CR⁺)-positive gamma-aminobutyric-acid (GABA)ergic inhibitory inter-neurons, and the expression levels of vesicular transporters of glutamate-1 (VGluT1) and vesicular GABA transporter (VGAT) in three stress-sensitive regions of the brain (the medial pre-frontal cortex [mPFC], hippocampus, and amygdala).

Behaviorally, compared with the control group, adolescent chronic stress increased depression-like behaviors as shown in decreased sucrose preference (54.96 ± 1.97% vs. 43.11 ± 2.85%, t₍₂₂₎ = 3.417, P = 0.003) and reduced latency to immobility in the tail suspension test (92.77 ± 25.08 s vs. 33.14 ± 5.95 s, t₍₂₅₎ = 2.394, P = 0.025), but did not affect anxiety-like behaviors and pre-pulse inhibition. At the neurobiologic level, adolescent stress down-regulated PV⁺, not CR⁺, inter-neuron density in the mPFC (F_{(1, 39)} = 19.30, P < 0.001), and hippocampus (F_{(1, 42)} = 5.823, P = 0.020) and altered the CR⁺, not PV⁺, inter-neuron density in the amygdala (F_{(1, 28)} = 23.16, P < 0.001). The VGluT1/VGAT ratio was decreased in all three regions (all F > 10.09, all P < 0.004), which suggests stress-induced hypoexcitability in these regions.

Chronic stress during adolescence increased depression-like behaviors in aged mice, which may be associated with the E/I imbalance in stress-sensitive brain regions.

More than ten genome-wide association studies have identified the significant association between the gap junction delta-2 (GJD2) gene and myopia. However, no functional studies have been performed to confirm that this gene is correlated with myopia. This study aimed to observe how this gene changed in mRNA and protein level in the form-deprivation myopia (FDM) animal model.

Four-week-old guinea pigs were randomly divided into two groups: control and FDM groups (n = 12 for each group). The right eyes of the FDM group were covered with opaque hemispherical plastic lenses for 3 weeks. For all the animals, refractive status, axial length (AL), and corneal radius of curvature were measured at baseline and 3 weeks later by streak retinoscope, A-scan ultrasonography, and keratometer, respectively. Retinal GJD2 mRNA expression and connexin 36 (Cx36) levels in FDM and control groups were measured by quantitative real-time PCR and Western blot analyses, respectively. Those results were compared using independent t test, Mann-Whitney U test, or paired t test. A significance level of P < 0.05 was used.

Three weeks later, the FDM group (form-deprived eyes) showed about a myopic shift of approximately -6.75 (-7.94 to -6.31) D, while the control group remained hyperopic with only a shift of -0.50 (-0.75 to 0.25) D (Z=-3.38, P < 0.01). The AL increased by 0.74 (0.61–0.76) and 0.10 (0.05–0.21) mm in FDM and control groups, respectively (Z = -3.37, P < 0.01). The relative mRNA expression of GJD2 in the FDM group decreased 31.58% more than the control group (t = 11.44, P < 0.01). The relative protein expression of CX36 on the retina was lowered by 37.72% in form-deprivation eyes as compared to the controls (t = 17.74, P < 0.01).

Both the mRNA expression of GJD2 and Cx36 protein amount were significantly decreased in the retina of FDM guinea pigs. This indicates that Cx36 is involved in FDM development, providing compensating evidence for the results obtained from genome-wide association studies.

Pulsed radiofrequency (PRF) is a minimally invasive interventional technique that provides a novel and effective treatment strategy for neuropathic pain (NP). PRF is advantageous because it does not damage nerves and avoids sensory loss after treatment. At present, animal studies have demonstrated that PRF is safe and effective for relieving the NP associated with sciatic nerve damage in rats with chronic constriction injury (CCI). However, the mechanism through which this effect occurs is unknown. An increasing body of evidence shows that the expression of the P2X ligand-gated ion channel 3 (P2X₃) receptor is closely related to NP; this study was to investigate whether the expression of this receptor is involved in NP relief due to PRF.

A total of 36 healthy adult male Sprague-Dawley (SD) rats were randomly divided into three groups: Sham group, CCI group, and PRF group. The right sciatic nerve was ligated in CCI group and PRF group to establish a CCI model; the right sciatic nerve was separated but not ligated in Sham group. On day 14 after the operation, PRF was administered to the ligated sciatic nerve in PRF group (42°C, 45 V, 2 min). A non-live electrode was placed at the exposed sciatic nerve for the rats in Sham and CCI groups. The hindpaw withdrawal threshold (HWT) and thermal withdrawal latency (TWL) were measured at the right hindpaw at different time points before and after PRF or sham therapy. On day 28 after treatment, the dorsal root ganglion (DRG) and spinal dorsal horn of the right L4–6 were harvested from each group to determine the mRNA and protein levels of the P2X₃ receptor.

On day 28 after PRF treatment, the HWT (8.33 ± 0.67 g vs. 3.62 ± 0.48 g) and TWL (25.42 ± 1.90 s vs. 15.10 ± 1.71 s) were significantly higher in PRF group as compared to CCI group (P < 0.05). The mRNA expression of the P2X₃ receptor in the DRG in PRF group was 23.7% lower than that in CCI group (P < 0.05), in the spinal dorsal horns in PRF group was 22.7% lower than that in CCI group (P < 0.05). The protein expression of the P2X₃ receptor in the DRG in PRF group was 27.8% lower than that in CCI group (P < 0.05), in the spinal dorsal horns in PRF group was 35.6% lower than that in CCI group (P < 0.05).

PRF possibly reduces NP in CCI rats by inhibiting the expression of the P2X₃ receptor in the L4–6 DRG and spinal dorsal horns.

Cryoglobulinemia often causes systemic vasculitis, thereby damaging to skin and internal organs including kidneys, even life-threatening. This review aimed to introduce the advances in understanding, detection, and treatment of this disease in recent years, with a particular concern to clinical practice.

All the data in this review were from the English or Chinese literature in the PubMed and China National Knowledge Infrastructure databases as of March 2019.

This review selected important original articles, meaningful reviews, and some reports on cryoglobulinemia published in recent years and in history, as well as the guidelines for treatment of underlying diseases which lead to cryoglobulinemia.

Diagnosis of cryoglobulinemia relies on serum cryoglobulin test, in which to ensure that the blood sample temperature is not less than 37°C in the entire pre-analysis phase is the key to avoid false negative results. Cryoglobulinemic vasculitis (Cryo Vas), including cryoglobulinemic glomerulonephritis (Cryo GN), usually occurs in types II and III mixed cryoglobulinemia, and can also be seen in type I cryoglobulinemia caused by monoclonal IgG3 or IgG1. Skin purpura, positive serum rheumatoid factor, and decreased serum levels of C4 and C3 are important clues for prompting types II and III Cryo Vas. Renal biopsy is an important means for diagnosis of Cryo GN, while membranous proliferative GN is the most common pathological type of Cryo GN. In recent years, great advances have been made in the treatment of Cryo Vas and its underlying diseases, and this review has briefly introduced these advances.

Laboratory examinations of serum cryoglobulins urgently need standardization. The recent advances in the diagnosis and treatment of Cryo Vas and GN need to be popularized among the clinicians in related disciplines.

Modern medical research has proven that human diseases are directly or indirectly related to genes. At the same time, genetic research has also brought updates to diagnostic techniques. Olfactomedin-like 3 (OLFML3) gene is a novel and clinically valuable gene. In order to better understand the role of OLFML3 in human diseases, we discuss and analyze the characteristics, function, and regulation mechanism of the OLFML3 gene in this review.

A comprehensive search in PubMed and ScienceDirect database for English up to March 2019, with the keywords of "Olfactomedin-like 3," "Olfactomedin," "extracellular matrix," "Transforming Growth Factor β1," "anoikis-resistance," and "microRNA-155."

Careful review of all relevant literature, the references of the retrieved articles were also screened to search for potentially relevant papers.

OLFML3 is a secreted glycoprotein with 406 amino acid residues, belonging to the Olfactomedin (OLF) family. Due to the particularity of its structure and differential expression, OLFML3 has unique biological functions that could be distinct from other members in the OLF family. The currently known functions include embryonic development function and tumorigenesis. The regulation mechanism is still under investigation. It is directly related to many human diseases.

OLFML3 is a multifunctional glycoprotein that is closely involved in embryonic development, tumor invasion, and metastasis. Unfortunately, current research on this important molecule is still very limited. Further investigations on the possible mechanism of OLFML3 biological functions and modulation will help us develop better diagnostics and treatments.

The National Health Commission of the People’s Republic of China (NHC) made a revision on the original version of theRegulation on the Clinical Application of Medical Technologyin November 2018.^[1]According to the new policy, medical institutions are endowed with the primary responsibility for the management of medical technology. This study aimed to investigate into the development and evolution of policy reform to explore the changes in the concepts and ideas of medical technology management in Chinese medical institutions.

Aspergillusis widespread in the environment and causes a variety of tracheobronchial and pulmonary disorders, depending upon the alterations of immune status of hosts.^[1]Among the spectrum of pulmonary aspergillosis (PA), allergic bronchopulmonary aspergillosis, and most chronic pulmonary aspergillosis are considered as noninvasive diseases, whereas invasive pulmonary aspergillosis (IPA) and subacute invasive pulmonary aspergillosis (SAIA) may cause tissue invasion.

To the Editor:With the development of minimally invasive surgical technology, laparoscopic transcystic common bile duct exploration plus laparoscopic cholecystectomy (LTCBDE + LC) has become the first choice of treatment for cholecystolithiasis combined with biliary calculi. In addition, there is little prospective research.

To the Editor:Morbidly obese patients are known to be difficult for facemask ventilation and tracheal intubation, leading to an increased risk for a "cannot intubate cannot ventilate" situation. Awake tracheal intubation is often considered as one of the safest strategies for anesthesia induction and airway management in patients with known or predicted difficult airways, but the technique itself is an uncomfortable procedure. When the tracheal intubation is performed under general anesthesia in patients with known or predicted difficult airways; however, the thing that anesthesiologists mostly concern is difficult facemask ventilation. Thus, the development of a strategy for always maintaining adequate ventilation and oxygenation throughout each step of airway security in anesthetized patients with known or predicted difficult airways is important.^[1]In this observational study, we assessed the feasibility and safety of a new strategy for anesthesia induction and airway management, in which sevoflurane inhaled anesthesia with spontaneous breathing was first used for insertion of supraglottic airway device (SAD) and then routine intra-venous anesthesia and neuromuscular blockade were applied for tracheal intubation via the SAD in morbidly obese patients.

To the Editor:Osteoporosis is becoming a common, serious, and costly health problem, which causes over nine million fractures annually worldwide.^[1]Currently, osteoporotic fractures are a considerable burden to public health services and have fairly high morbidity and mortality.^[2]Vertebral fractures are the most common osteoporotic fracture and may lead to a high risk of further fracture and could be prevalent in both females and males.^[3]Linget al^[4]and Ms. OS studies^[5]evaluated the prevalence of vertebral fractures in Beijing and Hong Kong, respectively. However, our knowledge of the descriptive epidemiology and risk factors for vertebral fracture in China still remains poor.

To the Editor:With interest we read the article by Fuet al^[1]about a 35-year-old male patient with late-onset myoclonic epilepsy with ragged red fibers syndrome (MERRF) plus syndrome being attributed to theMT-TNvariant m.5703G>A. We have the following comments and concerns.

To the Editor:Kawasaki disease (KD) and its classical diagnostic criteria are well known to pediatricians nowadays. However, KD can present with substantial overlap of clinical picture with many infectious diseases. Recently it is increasingly recognized that KD can present as pyogenic abscess-like formation with retropharyngeal edema (RPE). As estimated by Yoskovitchet al,^[1]5% of KD presented with some forms of deep neck infection. They could be in various forms, such as peritonsillar abscess, parapharyngeal or retropharyngeal abscess-like edema or acute mastoiditis. Not only do they mimic retropharyngeal abscess clinically, some with incomplete presentation may also contribute to delayed diagnosis and hence timely treatment. In this case series, we reported our experience in managing 24 cases of KD presenting with RPE.

To the Editor:Adams-Oliver syndrome (AOS, including 6 types) was initially reported in a three-generation family by Adams and Oliver in 1945,^[1]with an estimated incidence of 1 in 225,000 live births.^[2]Approximately 84% of AOS patients have terminal transverse limb defects, including amputations, syndactyly, brachydactyly, or oligodactyly. Congenital cutis aplasia is the second most common defect, occurring in 75% of AOS cases covering the posterior parietal region.^[3]Other features include vascular anomalies (20%), cardiovascular diseases (20%), central nervous system anomalies and gastrointestinal malformations.^[4]To date, six genes associated with AOS have been identified. Mutations inDOCK6(MIM: 614219, AOS type 2) andEOGT(MIM: 615297, AOS type 4) have been linked to the autosomal-recessive form of AOS, while mutations inARHGAP31(MIM: 100300, AOS type 1),RBPJ(MIM: 614814, AOS type 3),NOTCH1(MIM: 616028, AOS type 5) andDLL4(MIM: 616589, AOS type 6) cause the autosomal-dominant form. A recent study showed that mutations inNOTCH1(about 10%) were the most common cause of AOS in a large European cohort, followed by mutations inDLL4(about 6%),DOCK6(about 6%),ARHGAP31(about 3%),EOGT(about 3%), andRBPJ(about 2%).^[5]

To the Editor:The incidence of pulmonary atresia with intact ventricular septum (PA/IVS) is 1.9% in congential heart disease. The most serious manifestation is hypoplastic right heart syndrome (HRHS). HRHS and low birth weight have been determined as the major risk factors of fetal death after birth. Fetal pulmonary valvuloplasty (FPV) could relieve obstruction of the right ventricular outflow tract, restore growth potential of right ventricle, and increase the chances of biventricular circulation. However, so far fewer than 70 HRHS cases have been reported at the International Fetal Cardiac Intervention Registry (http://www.ifcir.org/) and there is a lack of postnatal treatment experience.

To the Editor:Metastatic melanoma is a fatal disease with rapid systemic dissemination and a 5-year survival rate of about 17%.^[1]More than half of primary metastases involve the skin as nodal, subcutaneous, or distant metastasis.^[2]Cutaneous metastases of melanoma occur relatively frequently and can arise in early- or late-stage disease, with a variable clinical appearance and pattern distribution.^[3]We describe herein a patient with a large subcutaneous nodule on the arm that we initially diagnosed as a lipoma. After obtaining further clinical history and reviewing the pathologic findings after excision, the nodule was determined to represent metastatic melanoma.

We have read with great interest the article "Heterotopic ossification after arthroscopy for hip impingement syndrome" by Gaoet al.^[1]

In the article titled "Co-existence ofbla_OXA-23andbla_VIMin carbapenem-resistantAcinetobacter baumanniiisolates belonging to global complex 2 in a Chinese teaching hospital," published on pages 1166-1672, Issue 10, Volume 132 ofChinese Medical Journal,^[1]the corrected Figure 1 could be seen in the linkage http://links.lww.com/CM9/A66.

Dr. Chuan-Han Feng, a member of Communist Party of China, leading authority of orthopedics in China, former president of Peking University People’s Hospital, first chairman of Chinese Medical Association Orthopedics Branch, founder of Department of Orthopedics in Peking University People’s Hospital, and former Editor in Chief ofChinese Medical Journal, passed away on June 16, 2019 at the age of 105.