2019年 · 第132卷第22期

Few data are available regarding the progression of liver disease and therapeutic efficacy in chronic hepatitis B virus (HBV) carriers infected by mother-to-child transmission (MTCT). This study aimed to investigate these two aspects by comparing the adult chronic HBV carriers in MTCT group with those in horizontal transmission group.

The 683 adult chronic HBV patients qualified for liver biopsy including 191 with MTCT and 492 with horizontal transmission entered the multi-center prospective study from October 2013 to May 2016. Biopsy results from 217 patients at baseline and 78 weeks post antiviral therapy were collected.

Patients infected by MTCT were more likely to have e antigen positive (68.6% vs. 58.2%, χ² = -2.491, P = 0.012) than those with horizontal transmission. However, in patients with MTCT, levels of alkaline phosphatase (ALP) (P = 0.031), Fibroscan (P = 0.013), N-terminal propeptide of Type III procollagen (PIIINP) (P = 0.014), and Laminin (LN) (P = 0.006) were high, in contrast to the patients with horizontal transmission for whom the levels of albumin (ALB) (P = 0.041), matrix metalloproteinase-3 (MMP-3) (P = 0.001) were high. The 47.2% of patients with MTCT and 36.8% of those with horizontal transmission had significant liver fibrosis (P = 0.013). Following antiviral therapy for 78 weeks, 21.2% and 38.0% patients with MTCT and horizontal transmission acquired hepatitis B e antigen (HBeAg) clearance, respectively (P = 0.043), and the virological response rates were 54.7% and 74.1% in the MTCT and horizontal groups, respectively (P = 0.005). MTCT was a risk factor for HBeAg clearance and virological response.

Adult patients with MTCT were more prone to severe liver diseases, and the therapeutic efficacy was relatively poor, which underlined the importance of earlier, long-term treatment and interrupting perinatal transmission.

NCT01962155; https://clinicaltrials.gov.

Coronary artery disease (CAD) in octogenarians (age of ≥80 years) has a high risk of mortality and high medical expenses. Research shows that the prevalence of CAD is higher among octogenarians than that among younger people, but few such patients undergo percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). This study aimed to evaluate different treatments with respect to their clinical effects and impacts on quality of life of octogenarians with CAD.

Data of 519 octogenarians with CAD consecutively treated at Beijing Anzhen Hospital, Capital Medical University (Beijing, China) from January 2010 to January 2016 were collected in this study. The patients were categorized into three groups based on the treatments they received: the PCI group (n = 292), CABG group (n = 110), and medical treatment group (n = 117). The followings were recorded during follow-up: clinical data, death (all-cause and cardiovascular-related), re-hospitalization time, Seattle Angina Questionnaire (SAQ) score, and occurrence of hemorrhagic events (cerebral bleeding, gastrointestinal bleeding, and dermal ecchymosis).

The median follow-up duration was 25.0 (25th, 75th percentile: 17.0, 55.5) months among 417 patients. The all-cause death rates (28.2% vs. 12.0% and 14.6%, respectively) and cardiovascular-related death rates (15.4% vs. 3.8% and 6.4%, respectively) were significantly higher in the medical treatment group than those in the PCI group and CABG group (all P < 0.05). The re-hospitalization rate for cardiovascular events was significantly lower in the CABG group than those in the PCI group and medical treatment group (3.8% vs. 12.8% and 14.9%, respectively) (χ² = 8.238, P = 0.018). The SAQ scores of physical limitation, angina frequency, treatment satisfaction, and disease perception were significantly higher in the PCI group and CABG group than those in the medical treatment group (all P < 0.05). No significant difference in the angina stability score was observed among the three groups (F = 3.179, P = 0.204).

PCI and CABG result in reduced mortality and better quality of life in octogenarians with CAD.

Colorectal cancer (CRC) has become one of the major life-threatening complications in patients with inflammatory bowel disease (IBD), which includes ulcerative colitis (UC) and Crohn’s disease (CD). This study aimed to explore the clinicalpathologic similarities and differences in the IBD-associated CRC (IBD-CRC) between patients in China and Canada.

Data of 78 patients with IBD-CRC retrospectively retrieved from two representative medical institutions in Beijing (China) and Calgary (Canada) over the same past 13 years, including 25 (22 UC-associated and three CD-associated) from Beijing group and 53 (32 UC-associated and 21 CD-associated) from Calgary group, were compared with regards to their clinical and pathologic characteristics.

Several known features of IBD-CRC were seen in both groups, including long duration and large extent of colitis, active inflammation background, multifocal lesions, and advanced tumor-node-metastasis stage. Beijing group showed a significantly higher percentage of UC (88.0% vs. 60.4%, P = 0.018), younger age at diagnosis of CRC (48.6 ± 12.8 years vs. 61.6 ± 14.7 years, P < 0.001), lower ratio of mucinous adenocarcinoma (7.1% vs. 42.4%, P = 0.001) compared with Calgary group. None of the Beijing group had concurrent primary sclerosing cholangitis, while 5.7% of Calgary group did. Surveillance colonoscopy favored the detection rate of precancerous lesions (41.4% vs.17.0%, P = 0.002).

As compared with patients from the Calgary group, the IBD-CRC patients in Beijing group were younger, less CD-associated and had less mucinous features, otherwise they were similar in many common features.

Obstructive sleep apnea hypopnea syndrome (OSAHS) is a contributing factor for non-alcoholic fatty liver disease (NAFLD). Non-invasive algorithms including fatty liver index (FLI) and hepatic steatosis index (HSI) have been used as a screening test for NAFLD in epidemiologic studies. The aim of this study is to compare the diagnostic accuracy of FLI and HSI for NAFLD detection in adults with OSAHS.

We enrolled consecutive adult subjects who were newly diagnosed with OSAHS from March 2016 to January 2018. NAFLD was diagnosed by ultrasonography. The accuracy and cut-off point of the FLI and HSI to detect NAFLD were assessed by analyzing the area under the receiver operating characteristic (AUROC) curve and the maximum Youden index analysis, respectively.

The 326 subjects were diagnosed as NAFLD according to ultrasound findings, while 105 subjects who had normal abdominal ultrasonography were grouped as controls. Both FLI and HSI values were significantly higher in patients with NAFLD compared with controls. The AUROC of FLI and HSI for predicting NAFLD was 0.802 (95% confidence interval [CI] 0.762-0.839) and 0.753 (95% CI 0.710-0.793), respectively. The AUROC of FLI was significantly higher than that of HSI (P = 0.0383). The optimal cut-off value of FLI and HSI was 60 (sensitivity 66% and specificity 80%) and 35 (sensitivity 81% and specificity 60%), respectively.

Both FLI and HSI can serve as screening tools for NAFLD in OSAHS adults. The FLI shows better performance in diagnosing NAFLD than HSI.

Chinese Clinical Trial Registry (No. ChiCTR-OOB-15007253), http://www.chictr.org.cn/showproj.aspx?proj=11606.

Trocar-site hernia (TSH) is a serious complication after laparoscopic procedures. Although it is a rare entity, it can have life-threatening consequences. This study aimed to retrospectively analyze the potential associated factors for TSH following gynecologic laparoscopy and summarize prevention strategies based on our experience.

We searched for gynecological laparoscopic surgeries in the medical records system of Peking Union Medical College Hospital (PUMCH) from August 1998 to July 2018 and further sifted through the results for cases involving TSH. All included patients were divided into different groups according to patient characteristics, and the rate of TSH was compared among groups. Moreover, the detailed information of all patients with TSH was recorded and analyzed. Statistical analyses were performed with GraphPad Prism 6.

The approximate total rate of post-operative TSH among gynecologic laparoscopy procedures performed at PUMCH in the last 20 years was 0.016% (9/55,244). The rate of TSH was significant higher in elder patients (≥60 years old; 3/2686, 0.112%) than in younger patients (<60 years old, 6/52,558; 0.011%, P = 0.008). Moreover, the approximate rate of TSH was significantly higher after single-incision laparoscopic surgery (SILS, 2/534, 0.357%) than conventional laparoscopic surgery (7/54,710, 0.013%, P = 0.003). The average age of patients with TSH was 53.4 years (range, 35.0-79.0 years). Two of the nine patients had late-onset TSH following SILS; the other seven had early-onset TSH following conventional laparoscopy. Five TSH cases occurred at right lateral port sites, and the remaining three occurred at the umbilical port site. All patients underwent repair surgery, and one required small bowel resection.

Older age and SILS are potential associated factors for TSH development, while reducing excessive manipulation and improving suturing skills, especially at the umbilical trocar site following SILS and the right lateral trocar site, can avoid herniation.

Due to the different treatments for low-volume metastatic prostate cancer (PCa) as well as high-volume ones, evaluation of bone metastatic status is clinically significant. In this study, we evaluated the correlation between pre-treatment plasma fibrinogen and the burden of bone metastasis in newly diagnosed PCa patients.

A single-center retrospective analysis, focusing on prostate biopsies of newly diagnosed PCa patients, was performed. A total of 261 patients were enrolled in this study in a 4-year period. All subjects were submitted to single-photon emission computerized tomography-computed tomography to confirm the status of bone metastasis and, if present, the number of metastatic lesions would then be calculated. Clinical information such as age, prostate-specific antigen (PSA), fibrinogen, clinical T stage, and Gleason score were collected. Patients were divided into three groups: (i) a non-metastatic group, (ii) a high volume disease (HVD) group (>3 metastases with at least one lesion outside the spine), and (iii) a low volume disease (LVD) group (metastatic patients excluding HVD ones). The main statistical methods included non-parametric Mann-Whitney test, Spearman correlation, receiver operating characteristic (ROC) curves, and logistic regression.

Fibrinogen positively correlated with Gleason score (r = 0.180, P = 0.003), PSA levels (r = 0.216, P < 0.001), and number of metastatic lesions (r = 0.296, P < 0.001). Compared with the non-metastatic and LVD groups, the HVD group showed the highest PSA (104.98 ng/mL, median) and fibrinogen levels (3.39 g/L, median), as well as the largest proportion of Gleason score >7 (86.8%). Both univariate (odds ratio [OR] = 2.16, 95% confidential interval [CI]: 1.536-3.038, P < 0.001) and multivariate (OR = 1.726, 95% CI: 1.206-2.472, P = 0.003) logistic regressions showed that fibrinogen was independently associated with HVD. The ROC curve suggested that fibrinogen acts as a predictor of HVD patients, yielding a cut-off of 3.08 g/L, with a sensitivity of 0.684 and a specificity of 0.760 (area under the curve = 0.739, 95% CI: 0.644-0.833, P < 0.001).

Pre-treatment plasma fibrinogen is positively associated with bone metastatic burden in PCa patients. Our results indicate that fibrinogen might be a potential predictor of HVD.

Previously, the authors modified the surgical technique to preserve tibial bone mass for Oxford unicompartmental knee arthroplasty (UKA). The purpose of this study was to determine the clinical outcomes and values of this modified technique.

Clinical data of 34 consecutive patients who underwent the unilateral modified UKA technique (modified group, 34 knees) were retrospectively analyzed. To compare the outcome, a match-paired control group (conventional group, 34 knees) of an equal number of patients using the conventional technique system in the same period were selected and matched with respect to diagnosis, age, pre-operative range of motion (ROM), and radiological grade of knee arthrosis. Clinical outcomes including knee Hospital for Special Surgery (HSS) score, ROM, and complications were compared between the two groups. Post-operative radiographic assessments included hip-knee-ankle angle (HKA), joint line change, implant position, and alignment.

The mean follow-up time was 38.2 ± 6.3 months. There was no difference in baseline between the two groups. The amount of proximal tibial bone cut in the modified group was significantly less than that of the conventional group (4.7 ± 1.1 mm vs. 6.7 ± 1.3 mm, t = 6.45, P < 0.001). Joint line was elevated by 2.1 ± 1.0 mm in the modified group compared with -0.5 ± 1.7 mm in the conventional group (t = -7.46, P < 0.001). No significant differences were observed between the two groups after UKA with respect to HSS score, VAS score, ROM, and HKA. Additionally, the accuracy of the post-operative implant position and alignment was similar in both groups. As for implant size, the tibial implant size in the modified group was larger than that in the conventional group (χ² = 4.95, P = 0.035).

The modified technique for tibial bone sparing was comparable with the conventional technique in terms of clinical outcomes and radiographic assessments. It can preserve tibial bone mass and achieve a larger cement surface on the tibial side.

Organ preservation has long been a consideration in the treatment of supraglottic and hypopharyngeal carcinoma to improve the quality of life (QOL). Definitive radiotherapy (DRT) with or without systematic treatment, such as chemotherapy, is always the first choice to achieve improved QOL. This retrospective study focused on the survival differences between DRT and surgery followed by adjuvant radiotherapy (S + RT) in supraglottic and hypopharyngeal carcinoma.

This study included adult patients with supraglottic or hypopharyngeal carcinoma undergoing single-modality treatment with either DRT or S + RT between January 2012 and August 2016. A total of 59 patients were identified, of whom 31 were treated with DRT, and 28 were treated with S + RT. In the 31 cases of DRT, 23 cases were treated with concurrent chemoradiotherapy (CRT), one case was treated with DRT plus cetuximab, and seven cases were treated with DRT alone. Of the other 28 cases of S + RT, 15 cases were treated with adjuvant concurrent CRT. Survival analysis was used to compare the overall survival (OS), local recurrence-free survival (LRFS) and distant metastasis-free survival (DMFS) between DRT and S + RT groups.

The median follow-up was 20 months (range, 4-67 months). The patients of the two groups were similar with respect to mean age, original sites, and tumor stages. The 1-, 2-, and 5-year OS rates were 80.6%, 53.4%, and 24.7% for the DRT group and 85.7%, 67.1%, and 24.7% for the S + RT group, respectively. There was no significant difference between the two groups (χ² = 3.183, P = 0.074). The 1-, 2-, and 5-year LRFS and DMFS were 90.4%, 61.7%, and 18.0% and 87.4%, 49.2%, and 9.9%, respectively, and no statistical difference was observed between the two groups (LRFS: χ² = 0.028, P = 0.868; DMFS: χ² = 3.347, P = 0.067). No significant difference was found between the two groups in acute radiotoxicity.

Without loss of laryngeal function, the survival of DRT is comparable to that of S + RT in supraglottic and hypopharyngeal carcinoma.

Malignant pleural effusion (MPE) is a complicated condition of patients with advanced tumors. Further dissecting the microenvironment of infiltrated immune cells and malignant cells are warranted to understand the immune-evasion mechanisms of tumor development and progression.

The possible involvement of microRNAs (miRNAs) in malignant pleural fluid was investigated using small RNA sequencing. Regulatory T cell (Treg) markers (CD4, CD25, forkhead box P3), and Helios (also known as IKAROS Family Zinc Finger 2 [IKZF2]) were detected using flow cytometry. The expression levels of IKZF2 and miR-4772-3p were measured using quantitative real-time reverse transcription polymerase chain reaction. The interaction between miR-4772-3p and Helios was determined using dual-luciferase reporter assays. The effects of miR-4772-3p on Helios expression were evaluated using an in vitro system. Correlation assays between miR-4772-3p and functional molecules of Tregs were performed.

Compared with non-malignant controls, patients with non-small cell lung cancer had an increased Tregs frequency with Helios expression in the MPE and peripheral blood mononuclear cells. The verified downregulation of miR-4772-3p was inversely related to the Helios⁺ Tregs frequency and Helios expression in the MPE. Overexpression of miR-4772-3p could inhibit Helios expression in in vitro experiments. However, ectopic expression of Helios in induced Tregs reversed the effects induced by miR-4772-3p overexpression. Additionally, miR-4772-3p could regulate Helios expression by directly targeting IKZF2 mRNA.

Downregulation of miR-4772-3p, by targeting Helios, contributes to enhanced Tregs activities in the MPE microenvironment.

Endostatin, a biologically active fragment of collagen XVIII, has been observed in patients with ischemic heart disease. The aim of the present study was to investigate whether endostatin overexpression could attenuate cardiac hypertrophy by inhibiting the cyclic adenosine monophosphate-protein kinase A (cAMP-PKA) signaling pathway.

This study was examined in vivo in rats and in vitro in primary neonatal rat cardiomyocytes treated with angiotensin (Ang) II to model cardiac hypertrophy. Twenty-four male Sprague-Dawley rats were randomized into adenovirus (Ad)-green fluorescent protein, Ang II, Ad-endostatin, and Ang II + Ad-endostatin groups (n = 6 in each group). Four weeks later, all the rats were weighed and sacrificed after transthoracic echocardiography. Cardiac function was evaluated by transthoracic echocardiography, cardiomyocyte size was evaluated by hematoxylin-eosin staining. Levels of atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) were evaluated by quantitative reverse-transcription polymerase chain reaction or Western blotting, PKA level was evaluated by Western blotting, and cAMP level was evaluated by enzyme-linked immunosorbent assay. Statistical significance among multiple groups was evaluated by one-way analysis of variance.

Endostatin overexpression reduced the increases in left ventricle (LV) mass (P = 0.0063), LV mass/body weight (BW) (P = 0.0013), interventricular septal thickness (IVS) in diastole (P = 0.0013), IVS in systole (P = 0.0056), left ventricular posterior wall thickness (LVPW) in diastole (P = 0.0291), LVPW in systole (P = 0.0080), heart weight (HW) (P = 0.0138), HW/BW (P = 0.0001), and HW/tibial length (P = 0.0372) in Ang II-treated rats. In addition, endostatin overexpression reduced cardiomyocyte cross-sectional area expansion, and reduced the levels of ANP and BNP in Ang II-treated rats (P = 0.0251 and 0.0477 for messenger RNA [mRNA]), and primary neonatal rat cardiomyocytes (P = 0.0188 and P = 0.0024 for mRNA; P = 0.0023 and 0.0013 for protein, respectively). Additionally, endostatin overexpression reduced the increase of cAMP (P = 0.0054) and PKA (P = 0.0328) levels in cardiomyocytes treated with Ang II. Treatment with cAMP reversed the effects of endostatin overexpression on ANP (P = 0.0263) and BNP (P = 0.0322) levels in cardiomyocytes induced by Ang II.

Endostatin overexpression could alleviate cardiac hypertrophy by inhibiting the cAMP-PKA signaling pathway.

This article aims to present a brief profile of the advances in prevention and treatment of myocardial injury in cancer therapy based on relevant literature or reports.

The data cited in this review were obtained from articles indexed in PubMed and China National Knowledge Internet (CNKI) up to June 2019.

Articles were selected with the following keywords "Anti-cancer therapy," "Myocardial injury," "Breast cancer," "Echocardiography," and "Chemotherapy."

Due to the rapid development of novel cancer therapeutic approaches, the life expectancy of tumor patients has been prolonged continuously. Meanwhile, a large number of studies have found that among patients benefiting from precise management, some medications have exerted direct or indirect side effects on the cardiovascular system, leading to the occurrence of myocardial injury. Because there are many common risk factors between breast cancer and cardiovascular disease, and there is a special anatomical position between breast and heart, the cardiology related to breast cancer patients is relatively unique in onco-cardiology.

Heart function monitoring is critical during anti-cancer therapy so that we can early identify cardiac abnormalities and actively adopt measures to prevent myocardial injury.

Pancreatic ductal adenocarcinoma cancer (PDAC) is one of the leading causes of cancer-related death worldwide. Hence, the development of effective anti-PDAC therapies is urgently required. Patient-derived xenograft (PDX) models are useful models for developing anti-cancer therapies and screening drugs for precision medicine. This review aimed to provide an updated summary of using PDX models in PDAC.

The author retrieved information from the PubMed database up to June 2019 using various combinations of search terms, including PDAC, pancreatic carcinoma, pancreatic cancer, patient-derived xenografts or PDX, and patient-derived tumor xenografts or PDTX.

Original articles and review articles relevant to the review’s theme were selected.

PDX models are better than cell line-derived xenograft and other models. PDX models consistently demonstrate retained tumor morphology and genetic stability, are beneficial in cancer research, could enhance drug discovery and oncologic mechanism development of PDAC, allow an improved understanding of human cancer cell biology, and help guide personalized treatment.

In this review, we outline the status and application of PDX models in both basic and pre-clinical pancreatic cancer researches. PDX model is one of the most appropriate pre-clinical tools that can improve the prognosis of patients with pancreatic cancer in the future.

To review the diagnosis of chronic wound biofilms and discuss current treatment approaches.

Articles included in this review were obtained from the following databases: Wanfang, China National Knowledge Infrastructure, PubMed, and the Web of Science. We focused on research published before August 2019 with keywords including chronic wound, biofilm, bacterial biofilms, and chronic wound infection.

Relevant articles were selected by carefully reading the titles and abstracts. Further, different diagnosis and clinical treatment methods for chronic wound biofilm were compared and summarized from the selected published articles.

Recent guidelines on medical biofilms stated that approaches such as the use of scanning electron microscopy and confocal laser scanning microscopy are the most reliable types of diagnostic techniques. Further, therapeutic strategies include debridement, negative pressure wound therapy, ultrasound, antibiotic, silver-containing dressing, hyperbaric oxygen therapy, and others.

This review provides the identification and management of biofilms, and it can be used as a tool by clinicians for a better understanding of biofilms and translating research to develop best clinical practices.

Osteoarthritis (OA) is a degenerative disease of articular cartilage whose main clinical manifestation is joint pain. The database from the China Health and Retirement Longitudinal Study showed that the morbidity of symptomatic OA (knee Kellgren and Lawrence score ≥2, with knee pain) was 8.1% in China. With the development of aging in China, the incidence of OA is rising. As there are no blood vessels, nerves, or lymph in articular cartilage, its self-healing ability is poor. There are many types of nonsurgical treatments, such as medications including non-steroidal anti-inflammatory drugs, glucocorticoid, or opioids,^[1,2]as well as physiotherapy treatments including injecting hyaluronic acid (HA) or platelet-rich plasma (PRP),^[3,4]to prevent pain and improve joint function. All of these methods can prevent pain temporarily but are unable to interrupt the degeneration of articular cartilage. After extracting fat from the human body using a liposuction device, microfragmented adipose tissue (MAT) can be obtained via an isolation and washing device without digestive enzymes.^[5]It supports threedimensional scaffolds, growing factors, and cellular colonies such as mesenchymal stem cells (MSCs). MAT injection can reduce pain in patients with OA, improve joint function, and does not cause adverse events.

Primary immune thrombocytopenia (ITP), a common hemorrhagic disease causing a tremendous burden to the social economy, is characterized by the bleeding of mucosa, skin, brain, and/or other important organs.^[1]Serious hemorrhage can even lead to death. Despite its seriousness, the golden criteria for ITP diagnosis and treatment are lacking. Consequently, much hinges upon physician experience as well as the willingness of patients and their families. In fact, standards for diagnosis and treatment of patients with ITP only appeared when the American Society of Hematology published a landmark guideline in 1996. It is important to find out hematologists’ routine strategies for managing ITP and the extent they have complied with or deviated from ITP guidelines. However, such research is few and far between. We published such a study in 2009.^[2]After that, the context for China-based hematologists diagnosing and treating ITP has undergone fundamental changes, including the publication of the Chinese Society of Hematology (CSH) guideline in 2011 and its update in 2016.^[3]

The clear cell renal cell carcinoma (ccRCC) appears to have a predilection for metastasizing to the pancreas.^[1]In the recent years, there are increasing numbers of clinical series from Europe and the United States that demonstrate encouraging survival results of pancreatic metastasectomy,^[2]but there are a few clinical data or only some case reports from East Asian population,^[3]and there are no specific guidelines regarding the appropriate management. The objective of this study was to present our experience of pancreatic metastasectomy from ccRCC by reporting the peri-operative and survival outcome.

The patients with acquired immunodeficiency syndrome (AIDS) are prone to opportunistic infections due to immune deficiencies. Because the AIDS virus is neuropathic, 10% of AIDS patients first manifested central nervous system (CNS) symptoms.^[1]More than 40% of untreated AIDS patients will develop CNS diseases.^[2]The diagnosis and treatment for AIDS complicated with intracranial lesions are mainly based on clinical experience and laboratory tests. If necessary, brain biopsies were taken into consideration to help to diagnose and choose a suitable therapy. In clinic practice, to get a specific diagnosis is very difficult. To further analyze the clinical features of such patients and to provide some suggestions for the clinical diagnosis and treatments, we retrospectively analyzed three AIDS cases with CNS infection who attended the Peking Union Medical College Hospital.

To the Editor:Mallet fracture is a very common hand injury. Although non-surgical treatment for some small fragment cases without distal interphalangeal joint (DIPJ) subluxation is acceptable, many authors have considered restoring the joint surface with accurate reduction to be important to prevent secondary osteoarthritis, loss of movement, and poor cosmetic outcomes.^[1]To obtain an accurate reduction, several reduction and fixation techniques (such as extension block pinning, hook plate fixation, umbrella handle like K-wire fixation, and so on) have been developed.^[2,3,4]But when the fracture fragment is small or comminuted, stable fixation is quite difficult to achieve based on the current techniques. To develop a more universal method to deal with different types of mallet fractures with fewer complications, a transverse two-hole mini plate was used.

To the Editor:Rheumatoid arthritis (RA) is a chronic inflammatory disorder characterized by synovial hyperplasia and joint destruction. The knee is the most commonly affected joint in patients with RA, and approximately 25% of patients with RA will undergo joint replacement within 22 years.^[1]Total-knee arthroplasty (TKA) is a successful treatment for patients with severe joint pain due to osteoarthritis or RA. Concerns regarding increased loosening rates and potential need for multiple revision surgeries have traditionally discouraged the use of TKA in patients under 60 years old.^[2]Although results in young patients are encouraging,^[3]little mid-term follow-up data are available. Other researchers focus on the controversial subject of resurfacing in TKA. Comparisons of the results in resurfaced and non-resurfaced arthroplasties have found no significant differences between the two groups, while others have argued that resurfacing of the patella should be performed routinely. Therefore, we reported the mid-term survival of a successful knee arthroplasty design in patients with RA under 60 years old and compared the difference between resurfacing group and non-resurfacing group.

To the Editor:A 66-year-old female complained of muscle weakness, numbness, and pain in her left shoulder and arm for 16 months, after which muscle atrophy and forearm swelling gradually developed. Before admission, she had been diagnosed with brachial plexus neuritis and received intravenous methylprednisolone with 500 mg for 3 days, followed by a tapering of oral prednisolone. However, she did not benefit much from the treatment. Her personal medical history and family history were not remarkable. The previous chest computed tomography (CT) scan and magnetic resonance imaging (MRI) scans of her brain, cervical spinal cord, and brachial plexus [Figure 1A] were not remarkable. Needle electromyography examination revealed the weakened motor unit recruitment with abnormal spontaneous activities, including positive sharp waves and fibrillations in the part of muscles innervated by left brachial plexus. The nerve conduction studies showed that compound muscle action potential and sensory nerve action potential amplitudes decreased greatly with prolonged distal latency in the muscles innervated by branches of left brachial plexus. This presentation was more readily visible in the inferior-trunk-innervated regions, such as ulnar-nerve-innervated muscles. Otherwise, the reduction of nerve conduction velocities was negligible.

To the Editor:A 44-year-old female presented at the local hospital for repeated episodes of having palpitations, accompanied with cold sweats, amaurosis, vomiting, and limb weakness in the previous 2 months. An electrocardiogram indicated "ventricular tachycardia" when she was not feeling well. The symptoms alleviated significantly after injections of "amiodarone" (dose unknown), after which the patient was discharged. A local physician recommended ablation, so the patient was transferred to our hospital. The patient was generally healthy and had lived in a region with pastures. According to the patient’ self-report, she had been diagnosed as having liver hydatidosis 30 years ago, but had recovered after surgical treatment at the local hospital. Furthermore, the patient claimed to have no other medical history. No hematological abnormality was found after admission but 24-h Holter monitoring indicated frequent premature ventricular contractions. Color Doppler echocardiography suggested significant attenuation of contraction at the apex of the ventricular septum, with apical thrombus.

To the Editor:Dermatofibrosarcoma protuberans is a type of poor to moderately differentiated tumor that accounts for 0.1% of all malignant tumors.^[1]This tumor type mainly occurs in the superficial skin and the subcutaneous tissue of the trunk and is rare in patients with breast cancer.^[2]Here, we report a patient with dermatofibrosarcoma protuberans of the breast whose tumors are irregular in shape.

To the Editor:By a retrospective study including 1124 hospitalized patients diagnosed with acute myocardial infarction (AMI), Wanget al^[1]showed that the independent risk factors for acute kidney injury (AKI) were age >60 years, hypertension, chronic kidney disease (CKD), Killip class ≥3, extensive anterior myocardial infarction, use of furosemide, non-use of angiotensin-converting enzyme inhibitors (ACEI)/angiotensin receptor blocker (ARB), and these factors could provide a prediction model with good discriminative ability for the development of AKI. Given that AKI has been significantly associated with morbidity and mortality of patients with AMI,^[2]their findings have potential clinical implications. Other than the limitations described by authors in the discussion; however, we noted some methodological issues in their study that needed further clarifications.

Gaoet al^[1]recently published a paper inChinese Medical Journalentitled "Research trends of macrophage polarization: a bibliometric analysis." In this article, Gaoet almentioned in Section Methods, that "Data were obtained from the Science Citation Index Expanded (SCI-E) database of the 'Web of Science Core Collection’ on October 25, 2017. The search query used was 'TS = (macrophage AND polarization).’ The timespan was set between the years 2007 and 2016, and the language was set to 'English,’ and document type was set to 'article.’ The search resulted in 3064 articles that met the inclusion criteria."