2020年 · 第133卷第02期

The role of local treatment in oligometastatic prostate cancer (PCa) is gaining interest with the oligometastases hypothesis proposed and the improvement of various surgical methods and techniques. This study aimed to compare the short-term therapeutic outcomes of robotic-assisted laparoscopic radical prostatectomy (RALP) for oligometastatic prostate cancer (OPC) vs. localized PCa using propensity score matching.

Totally 508 consecutive patients underwent RALP as a first-line treatment. The patients were divided into two groups according to oligometastatic state: the OPC group (n = 41) or the localized PCa group (n = 467). Oligometastatic disease was defined as the presence of two or fewer suspicious lesions. The association between the oligometastatic state and therapeutic outcomes of RALP was evaluated, including biochemical recurrence (BCR) and overall survival (OS). A Cox proportional hazards model was used to assess the possible risk factors for BCR.

Totally 41 pairs of patients were matched. The median operative time, the median blood loss, the overall positive surgical margin rate, the median post-operative hospital stays, and the post-operative urinary continence recovery rate between the two groups showed no statistical significance. The 4-year BCR survival rates of the OPC group and localized PCa group were 56.7% and 60.8%, respectively, without a significant difference (P= 0.804). The 5-year OS rates were 96.3% and 100%, respectively (P = 0.326). Additionally, the results of Cox regression showed that oligometastatic state was not an independent risk factor for BCR (P = 0.682).

Our findings supported the safety and effectiveness of RALP in OPC. Additionally, oligometastatic state and sites did not have an adverse effect on BCR independently.

The symptomatic bradyarrhythmia is Class I indication for pacing therapy which is not a radical cure. The present study aimed to assess the feasibility and to present the initial results of the restricted ablation of the parasympathetic innervation surrounding sinus and atrioventricular (AV) nodes for treating patients with bradyarrhythmia.

A total of 13 patients with cardiogenic syncope were included from May 2008 to June 2015. Under the guidance of fluoroscopy and /or three-dimensional geometry by 64-slice spiral computed tomography, atrial activation sequence in sinus rhythm was mapped. Chamber geometry was reconstructed manually or automatically using the Niobe II magnetic navigation system integrated with the CARTO-remote magnetic technology (RMT) system. Cardioneuroablation was targeted at the high-amplitude fractionated electrograms surrounding the regions of His bundle and the site with the earliest activation in sinus rhythm. Areas surrounding the sinus node, AV node, and the phrenic nerve were avoided.

Thirteen patients completed the studies. Ablation was successfully performed in 12 patients and failed in one. The high-frequency potential was recorded in atrial electrograms surrounding the sinus or AV nodes in all the patients and disappeared in 15 s after radiofrequency applications. The vagal reaction was observed before the improvement of the sinus and AV node function. No complications occurred during the procedures. Patients were followed up for a mean of 13.0 ± 5.9 months. During the follow up ten patients remained free of symptoms, and two patients had a permanent cardiac pacemaker implanted due to spontaneous recurrence of syncope. The heart rate of post-ablation was higher than pre-ablation (69.0 ± 11.0 vs. 49.0 ± 10.0 beats/min, t = 4.56, P = 0.008). The sinus node recovery time, Wenckebach block point, and atrium-His bundle interval were significantly shorter after ablation (1386.0 ± 165.0 vs. 921.0 ± 64.0 ms, t = 7.45, P = 0.002; 590.0 ± 96.0 vs. 464.0 ± 39.0 ms, t = 2.38, P = 0.023; 106.0 ± 5.0 vs. 90.0 ± 12.0 ms, t = 9.80, P = 0.013 before and after ablation procedure, respectively).

Ablation of sinoatrial and AV nodal peripheral fibrillar myocardium electrical activity might provide a new treatment to ameliorate paroxysmal sinus node dysfunction, high degree AV block, and vagal-mediated syncope.

Super-responders (SRs) to cardiac resynchronization therapy (CRT) regain near-normal or normal cardiac function. The extent of cardiac synchrony of SRs and whether continuous biventricular (BIV) pacing is needed remain unknown. The aim of this study was to evaluate the cardiac electrical and mechanical synchrony of SRs.

We retrospectively analyzed CRT recipients between 2008 and 2016 in 2 centers to identify SRs, whose left ventricular (LV) ejection fraction was increased to ≥50% at follow-up. Cardiac synchrony was evaluated in intrinsic and BIV-paced rhythms. Electrical synchrony was estimated by QRS duration and LV mechanical synchrony by single-photon emission computed tomography myocardial perfusion imaging.

Seventeen SRs were included with LV ejection fraction increased from 33.0 ± 4.6% to 59.3 ± 6.3%. The intrinsic QRS duration after super-response was 148.8 ± 30.0 ms, significantly shorter than baseline (174.8 ± 11.9 ms, P = 0.004, t = -3.379) but longer than BIV-paced level (135.5 ± 16.7 ms, P = 0.042, t = 2.211). Intrinsic LV mechanical synchrony significantly improved after super-response (phase standard deviation [PSD], 51.1 ± 16.5° vs. 19.8 ± 8.1°, P < 0.001, t= 5.726; phase histogram bandwidth (PHB), 171.7 ± 64.2° vs. 60.5 ± 22.9°, P < 0.001, t= 5.376) but was inferior to BIV-paced synchrony (PSD, 19.8 ± 8.1° vs. 15.2 ± 6.4°, P = 0.005, t = 3.414; PHB, 60.5 ± 22.9° vs. 46.0 ± 16.3°, P = 0.009, t = 3.136).

SRs had significant improvements in cardiac electrical and LV mechanical synchrony. Since intrinsic synchrony of SRs was still inferior to BIV-paced rhythm, continued BIV pacing is needed to maintain longstanding and synchronized contraction.

The aryl hydrocarbon receptor (AhR) is a ligand-activated transcription factor, which is critically involved in the pathogenesis of a variety of skin diseases. The aim of this study was to detect AhR and its downstream regulators including cytochrome P450 (CYP1A1), AhR nuclear translocation (ARNT), and aryl hydrocarbon receptor repressor (AhRR) in serum, peripheral blood mononuclear cells (PBMCs), and skin lesions in patients with atopic dermatitis (AD).

Twenty-nine AD patients defined according to the criteria of Hanifin and Rajka and Chinese criteria of AD were included. Subjects without allergic and chronic diseases were recruited as controls. Patients and controls were selected from the dermatology outpatient clinic of Peking University People’s Hospital from August 1 to December 31 in 2018. Enzyme-linked immunosorbent assay was performed to detect serum AhR level. The mRNA of AhR, AhRR, ARNT, and CYP1A1 in PBMCs were measured by realtime quantitative polymerase chain reaction. AhR expression in skin lesions was measured by immunohistochemistry.

AhR was significantly higher expressed in serum (41.26 ± 4.52 vs. 33.73 ± 2.49 pmol/L, t = 6.507, P < 0.001) and skin lesions (0.191 ± 0.041 vs. 0.087 ± 0.017, t = 10.036, P < 0.001) of AD patients compared with those of controls. The mRNA levels of AhR (1.572 ± 0.392 vs. 1.000 ± 0.173, t= 6.819, P < 0.001), AhRR (2.402 ± 1.716 vs. 1.000 ± 0.788, t= 3.722, P < 0.001), CYP1A1 (2.258 ± 1.598 vs. 1.000 ± 0.796, t= 3.400, P = 0.002) in PBMCs of AD patients were higher compared with those of controls. The difference in mRNA levels of ARNT was not statistically significant between the patients and controls (1.383 ± 0.842 vs. 1.000 ± 0.586, t= 1.653, P = 0.105). AhR mRNA levels in PBMCs positively correlated with eczema area and severity index score and serum interleukin-6 levels.

AhR and its downstream regulators were highly expressed in serum, PBMCs, and skin of AD patients, which might contribute to the pathogenesis of AD.

Gastric cancer (GC) is one of the most common malignancies, and intestinal-type GC is the main histopathologic type of GC in China. We previously reported that casein kinase 2 interacting protein 1 (CKIP-1) acts as a candidate tumor suppressor in intestinal-type GC. CKIP-1 participates in the regulation of multiple signaling pathways, including the Wnt/β-catenin pathway, of which caudal-related homeobox 1 (CDX1) may be a downstream target gene. The purpose of this study was to investigate the relationship between CKIP-1 and CDX1 in intestinal-type GC.

Sixty-seven gastroscopy biopsy specimens and surgically resected gastric specimens were divided into four groups: gastric mucosa group, intestinal metaplasia (IM) group, dysplasia group, and intestinal-type GC group. The expression levels of CKIP-1 and CDX1 were detected in these groups and GC cell lines, and the correlations between these expression levels were analyzed. SGC7901 and BGC823 cells were divided into CKIP-1 shRNA groups and CKIP-1 over-expression groups, and CDX1 expression was detected. β-Catenin expression was detected in intestinal-type GC tissue samples and CKIP-1 shRNA and CKIP-1 over-expression SGC7901 cells, and its correlation with CKIP-1 expression in intestinal-type GC tissue was analyzed. The Wnt/β-catenin pathway inhibitor DKK-1 and activator LiCl were incubated with SGC7901 cells, BGC823 cells, and CKIP-1 shRNA and CKIP-1 over-expression SGC7901 and BGC823 cells, following which CDX1 and Ki-67 expression were detected.

The expression levels of CKIP-1 and CDX1 were lower in patients with intestinal-type GC than in patients with IM and dysplasia (both P < 0.05). CKIP-1 and CDX1 expression levels were positively correlated in IM, dysplasia, and intestinal-type GC tissue and cell lines (r = 0.771, P < 0.01; r = 0.597, P < 0.01; r = 0.654, P < 0.01; r = 0.811, P < 0.01, respectively). CDX1 expression was decreased in the CKIP-1 shRNA groups and increased in the CKIP-1 over-expression groups of SGC7901 and BGC823 cells compared to that in the corresponding control groups (both P < 0.05). CKIP-1 expression was negatively correlated with β-catenin expression in intestinal-type GC patients (r = -0.458, P < 0.01). Compared to the control group, β-catenin expression was increased in the CKIP-1 shRNA SGC7901 cell group and decreased in the CKIP-1 over-expression SGC7901 cell group (P < 0.05). CDX1 expression was increased in SGC7901 and BGC823 cells treated with DKK-1, DKK-1 increased CDX1 expression and decreased Ki-67 expression in the CKIP-1 shRNA group; the opposite result was observed in SGC7901 and BGC823 cells treated with LiCl, and LiCl decreased CDX1 expression and increased Ki-67 expression in the CKIP-1 over-expression group (both P < 0.05).

Through the Wnt/β-catenin signaling pathway, CKIP-1 may positively regulate CDX1 in intestinal-type GC.

Andersson lesions (ALs), also known as spondylodiscities, destructive vertebral lesions and spinal pseudarthrosis, usually occur in patients with ankylosing spondylitis (AS). Inflammatory and traumatic causes have been proposed to define this lesion. Different surgical approaches including anterior, posterior, and combined anterior and posterior procedure have been used to address the complications, consisting of mechanical pain, kyphotic deformity, and neurologic deficits. However, the preferred surgical procedure remains controversial. The aim of this study was to illustrate the safety, efficacy, and feasibility of a modified posterior wedge osteotomy for the ALs with kyphotic deformity in AS.

From June 2008 to January 2013, 23 patients (18 males, 5 females) at an average age of 44.8 years (range 25–69 years) were surgically treated for thoracolumbar kyphosis with ALs in AS via a modified posterior wedge osteotomy in our department. All sagittal balance parameters were assessed by standing lateral radiography of the whole spine before surgery and during the follow-up period. Assessment of radiologic fusion at follow-up was based on the Bridwell interbody fusion grading system. Ankylosing spondylitis quality of life (ASQoL) and visual analog scale (VAS) scores were performed to evaluate improvements in daily life function and back pain pre-operatively and post-operatively. Paired t tests were used to compare clinical data change in parametric values before and after surgery and the Mann-Whitney U test was employed for non-parametric comparisons. The radiographic data change was evaluated by repeated measure analysis of variance.

The mean operative duration was 205.4 min (range 115–375 min), with an average blood loss of 488.5 mL (range 215–880 mL). Radiographical and clinical outcomes were assessed after a mean of 61.4 months of follow-up. The VAS back pain and ASQoL scores improved significantly in all patients (7.52 ± 1.31 vs. 1.70 ± 0.70, t= 18.30, P < 0.001; 13.87 ± 1.89 vs. 7.22 ± 1.24, t= 18.53, P < 0.001, respectively). The thoracolumbar kyphosis (TLK) changed from 40.03 ± 17.61° pre-operatively to 13.86 ± 6.65° post-operatively, and 28.45 ± 6.63° at final follow-up (F = 57.54, P < 0.001), the thoracic kyphosis (TK) changed from 52.30 ± 17.62° pre-operatively to 27.76 ± 6.50° post-operatively, and 28.45 ± 6.63° at final follow-up (F = 57.29, P < 0.001), and lumbar lordosis (LL) changed from -29.56 ± 9.73° pre-operatively to -20.58 ± 9.71° post-operatively, and -20.73 ± 10.27° at final follow-up (F = 42.50, P < 0.001). Mean sagittal vertical axis (SVA) was improved from 11.82 ± 4.55 cm pre-operatively to 5.12 ± 2.42 cm post-operatively, and 5.03 ± 2.29 cm at final follow-up (F = 79.36, P < 0.001). No obvious loss of correction occurred, according to the lack of significant differences in the sagittal balance parameters between post-operatively and the final follow-up in all patients (TK: 27.76 ± 6.50° vs. 28.45 ± 6.63°, TLK: 13.86 ± 6.65° vs. 14.42 ± 6.7°, LL: -20.58 ± 9.71° vs. -20.73 ± 10.27°, and SVA: 5.12 ± 2.42 cm vs. 5.03 ± 2.29 cm, all P > 0.05, respectively).

The modified posterior wedge osteotomy is an accepted surgical procedure for treating thoracolumbar kyphosis with ALs in AS and results in satisfactory local kyphosis correction, solid fusion, and good clinical outcomes.

Glioblastoma is one of the most common malignant brain tumors. Conventional clinical treatment of glioblastoma is not sufficient, and the molecular mechanism underlying the initiation and development of this disease remains unclear. Our study aimed to explore the expression and function of miR-873a-5p in glioblastoma and related molecular mechanism.

We analyzed the most dysregulated microRNAs from the Gene Expression Omnibus (GEO) database and examined the expression of miR-873-5p in 20 glioblastoma tissues compared with ten normal brain tissues collected in the Zhejiang Tongde Hospital. We then overexpressed or inhibited miR-873-5p expression in U87 glioblastoma cell lines and analyzed the phenotype using the cell counting kit-8 assay, wound healing assay, and apoptosis. In addition, we predicted upstream and downstream genes of miR-873-5p in glioblastoma using bioinformatics analysis and tested our hypothesis in U87 cells using the luciferase reporter gene assay and Western blotting assay. The differences between two groups were analyzed by Student’s t test. The Kruskal-Wallis test was used for the comparison of multiple groups. A P < 0.05 was considered to be significant.

The miR-873-5p was downregulated in glioblastoma tissues compared with that in normal brain tissues (normal vs. tumor, 0.762 ± 0.231 vs. 0.378 ± 0.114, t= 4.540, P < 0.01). Overexpression of miR-873-5p inhibited cell growth (t= 6.095, P < 0.01) and migration (t= 3.142, P < 0.01) and promoted cell apoptosis (t= 4.861, P < 0.01), while inhibition of miR-873-5p had the opposite effect. Mechanistically, the long non-coding RNA HOTAIRM1 was found to act as a sponge of miR-873-5p to activate ZEB2 expression in U87 cells.

We uncovered a novel HOTAIRM1/miR-873-5p/ZEB2 axis in glioblastoma cells, providing new insight into glioblastoma progression and a theoretical basis for the treatment of glioblastoma.

Obstetric hemorrhage is a major cause of maternal death during cesarean delivery. The objective of this retrospective observational study was to evaluate the efficacy and safety of intra-operative cell salvage (IOCS) in cesarean section.

We included a total of 361 patients diagnosed with central placenta previa who underwent cesarean section from May 2016 to December 2018. In this study, 196 patients received autologous transfusion using IOCS (IOCS group) and 165 patients accepted allogeneic blood transfusion (ABT group). Propensity score matched analysis was performed to balance differences in the baseline variables between the IOCS group and ABT group. Patients in the IOCS group were matched 1:1 to patients in the ABT group.

After propensity score matching, 137 pairs of cases between the two groups were successfully matched and no significant differences in baseline characteristics were found between the IOCS group and ABT group. Patients in the IOCS group were associated with significantly shorter length of hospital stay, compared with ABT group (8.9 ± 4.1 days vs. 10.3 ± 5.2 days, t= -2.506, P = 0.013). The postoperative length of hospital stay was 5.3 ± 1.4 days for patients in the IOCS group and 6.6 ± 3.6 days for those in the ABT group (t = -4.056, P < 0.001). The post-operative hemoglobin level in the IOCS group and ABT group was 101.3 ± 15.4 and 96.3 ± 16.6 g/L, respectively, which were significantly different (t= 2.615, P= 0.009). Allogeneic red blood cell transfusion was significantly lower at 0 unit (range: 0–11.5 units) in the IOCS group when compared with 2 units (range: 1–20 units) in the ABT group (P < 0.001).

This retrospective observational study using propensity score matched analysis suggested that IOCS was associated with shorter length of postoperative hospital stay and higher post-operative hemoglobin levels during cesarean delivery.

Pulsed radiofrequency (PRF), as a non-invasive treatment of neuropathic pain (NP), has been widely administered clinically. Previous studies have shown that PRF has the potential to improve hyperalgesia in animal models of NP. However, there have been few reports to clarify whether the mechanism of PRF treatment of NP involves intervention in the expression of substance P (SP). Therefore, this study administered PRF treatment to chronic constriction injury (CCI) model rats and observed the sciatic nerve mechanical pain threshold and SP expression in the spinal cord to explore the mechanism of PRF treatment.

A total of 96 Sprague-Dawley rats were randomly divided into the sham-surgery-sham-treatment group (S-S group), the sham-surgery-PRF group (S-P group), the CCI-sham-treatment group (C-S group), and the CCI-PRF group (C-P group). The C-S group and the C-P group underwent sciatic nerve CCI, while the other groups received a sham operation. At 14 days after the operation, the C-P group and the S-P group were treated with PRF for 300 s. We recorded the hindpaw withdrawal threshold (HWT) and the thermal withdrawal latency (TWL) of rats in the various groups at baseline, before treatment (0 days), and at 1, 7, 14, and 28 days after treatment. L4 to L6 spinal cord tissues were taken before treatment (0 days) and 1, 7, 14, and 28 days after treatment. The transcription and translation of SP were measured by quantitative polymerase chain reaction and Western blotting, respectively.

The HWT and the TWL in the C-P group 28 days after PRF treatment were significantly higher than those in the C-S group (95% confidence interval [CI]: 5.84–19.50, P < 0.01; 95% CI: 2.58–8.69, P = 0.01). The expression of SP in the C-P group 28 days after PRF treatment was significantly lower than that in the C-S group (95% CI: 1.17–2.48, P < 0.01).

PRF may alleviate CCI-induced NP by down-regulating the expression of SP in the spinal cord of CCI model rats.

Previously, dihydroceramide (d18:0/24:0) (dhCer (d18:0/24:0)) was reported to be a potential biomarker for acute-onchronic liver failure (ACLF) prognosis. In this study, we further explored the role of dhCer (d18:0/24:0) in the progression of ACLF to validate the biomarker using ACLF rat model.

ACLF rats were sacrificed at 4 and 8 h post-D-galactosamine (D-gal)/lipopolysaccharide (LPS) administration to investigate the liver biochemical markers, prothrombin time and liver histopathology. Change in dhCer and other sphingolipids levels were investigated by high-performance liquid chromatography coupled to tandem mass spectrometry (HPLC-MS/MS). Rats were treated with N-(4-hydroxyphenyl) retinamide (4-HPR) to examine the mortality rate and its role in improving ACLF.

LPS/D-gal administration resulted in significant elevation in alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels. Prothrombin time was prolonged and histopathological examination showed abnormality. HPLC-MS/MS results showed total dhCer levels in ACLF group (64.10 ± 8.90 pmol/100 μL, 64.22 ± 6.78 pmol/100 μL for 4 and 8 h, respectively) were decreased significantly compared with control group (121.61 ± 23.09 pmol/100 μL) (P < 0.05). In particular, dhCer (d18:0/24:0), dhCer (d18:0/20:0), and dhCer (d18:0/22:0) levels were decreased. Treatment with 4-HPR significantly increased the levels of dhCers, including dhCer (d18:0/24:0) compared with ACLF group, for the level of dhCer (d18:0/24:0) in 4-HPR group was 20.10 ± 8.60 pmol/100 μL and the level of dhCer (d18:0/24:0) in ACLF group was 9.74 ± 2.99 pmol/100 μL (P < 0.05). This was associated with reduced mortality rate and prolonged survival time. The ALT and AST in 4-HPR group were significantly decreased compared with ACLF group. The prothrombin time of 4-HPR group (41.49 s) was significantly lower than the prothrombin time of ACLF group (57.96 s) (P < 0.05). 4-HPR also decreased plasma ammonia levels slightly, as the plasma ammonia levels in 4-HPR group and ACLF group were 207.37 ± 60.43, 209.15 ± 60.43 μmol/L, respectively. Further, 4-HPR treatment improved histopathological parameters.

DhCer, especially dhCer (d18:0/24:0), is involved in the progression of ACLF. Increasing the levels of dhCer can reduce the mortality rate of ACLF rats and alleviate liver injury.

Recent evidence has shown that prophylactic antibiotic treatment in patients with acute pancreatitis is not associated with a significant decrease in mortality or morbidity. The use and efficacy of prophylactic antibiotic treatment in acute pancreatitis remain controversial. This meta-analysis was conducted to assess whether antibiotic prophylaxis is beneficial in patients with acute pancreatitis.

We searched randomized controlled trials (RCTs) of prophylactic use of antibiotics using Medline (PubMed), Embase, the Cochrane Library, and Web of Science. The data were analyzed using Review Manager 5.3 software. We performed pooled analyses for infected pancreatic necrosis, mortality, surgical intervention, and non-pancreatic infection. Odds ratios (ORs) from each trial were pooled using a random or fixed effects model, depending on the heterogeneity of the included studies. Sub-group analysis or sensitivity analysis was conducted to explore potential sources of heterogeneity, when necessary.

Totally, 11 RCTs involving 747 participants were included, with an intervention group (prophylactic use of antibiotics, n = 376) and control group (n = 371). No significant differences were found regarding antibiotic prophylaxis with respect to incidence of infected pancreatic necrosis (OR, 0.74; 95% confidence interval [CI], 0.50–1.09; P = 0.13), surgical intervention (OR, 0.92; 95% CI, 0.62–1.38; P = 0.70), and morality (OR, 0.71; 95% CI, 0.44–1.15; P = 0.16). However, antibiotic prophylaxis was associated with a statistically significant reduction in the incidence of non-pancreatic infection (OR, 0.59; 95% CI, 0.42–0.84; P = 0.004).

Prophylactic antibiotics can reduce the incidence of non-pancreatic infection in patients with AP.

Alternative splicing can generate various structural and functional protein isoforms. Recently, accumulating evidence shows a relationship between alternative splicing and cancer. Cancer is a complex and chronic disease that involves malignant transformation. In this review, we consider alternative splicing events in relation to the hallmarks of cancer cells, and discuss current therapies to treat cancer-related to alternative splicing.

Data cited in this article are from the PubMed and Embase database, primarily focusing on research published from 2000 to 2018.

Articles were selected with the search terms "alternative splicing," "cancer cell," "tumor microenvironment," and "therapy."

Alternative splicing plays an important role in tumorigenesis, development, and escape from cell death. Taking this trait of cancer cells into consideration will allow more definite diagnoses of cancer, and allow the development of more effective medicines to intervene in cancer that could focus on controlling alternative splicing or competitively binding to the final products.

Alternative splicing is common in cancer cells. Consideration of alternative splicing may allow different strategies for cancer therapy or the identification of novel biomarkers for cancer diagnosis.

The oxygen reserve index (ORI) is a new technology that provides real-time, non-invasive, and continuous monitoring of patients' oxygenation status. This review aimed to discuss its clinical utility, prospect and limitations. A systematic literature search of PubMed, MEDLINE, Google Scholar, and ScienceDirect was performed with the keywords of "oxygen reserve index," "ORI," "oxygenation," "pulse oximetry," "monitoring," and "hyperoxia." Original articles, reviews, case reports, and other relevant articles were reviewed. All articles on ORI were selected. ORI can provide an early warning before saturation begins to decrease and expands the ability to monitor the human body’s oxygenation status noninvasively and continuously with the combination of pulse oximetry so as to avoid unnecessary hyperoxia or unanticipated hypoxia. Although the technology is so new that it is rarely known and has not been applied to routine practices in hospitals, it shows good prospects for critical care, oxygen therapy, and intraoperative monitoring.

To the Editor:As the most common benign neoplasm of the salivary gland, pleomorphic adenoma is characterized by slow progression and low morbidity.^[1]It is quite rare for the pleomorphic adenoma to metastasize before undergoing malignant transformation, resulting in that there is no clear consensus about the epidemiology, mechanism of development, treatment, and prognosis of metastasizing pleomorphic adenomas (MPA).^[2]According to the systematic review study of James Knight, 72.8% of cases reported pleomorphic adenoma (PA) local recurrence before MPA. MPA usually spread to the bone (36.6%), the lung (33.8%), and neck lymph nodes (20.1%).^[1]The case we reported was the pulmonary MPA of the salivary gland.

To the Editor:Sentinel lymph node biopsy has become a universal procedure performed in node-negative breast cancer patients. The accurate intra-operative assessment of the sentinel lymph node (SLN) is prominent in enabling axillary lymph node dissection (ALND) synchronously performed during the breast surgery, in case of the morbidity, inconvenience, and extra cost resulting from a second operation. One-step nucleic acid amplification (OSNA) assay (Sysmex, Kobe, Japan) is a moderately sensitive molecular technique combining node tissue homogenization and subsequent reverse-transcription loop-mediated isothermal amplification of cytokeratin-19 (CK-19) mRNA in a single reaction. The assay could accurately discern nodal metastases of over 0.2 mm intraoperatively.

To the Editor:Germ-cell tumors (GCTs) of the central nervous system (CNS), the morphologic, immunophenotypic, and (in some respects) genetic homologs of gonadal and other extraneuraxial germ-cell neoplasms, principally affect children and adolescents.^[1]The diagnosis of GCT of the CNS is not difficult, and the major GCT types are germinoma, teratoma, yolk sac tumor (YST), embryonal carcinoma, and choriocarcinoma. Neoplasms harboring multiple types are called mixed GCT (MGCT). Peak incidence of GCT of the CNS occurs in patients aged 10 to 14 years, and a clear majority of cases of all histologic types involve males. GCT of the CNS seems to be more prevalent in eastern Asia than in Europe and the United States.^[1,2,3,4,5]In Japan, 70% of patients with GCT of CNS aged 10 to 24 years and 73% were males,^[6]but there were limited Chinese patients' large-scale data, only two studies reported more than 100 cases.^[7,8]Were the types and clinical characteristics of GCTs in the CNS in Chinese patients consistent with Japan’s? We reviewed all cases of GCTs in the CNS diagnosed by pathology in Peking Union Medical College Hospital from year 1999 to 2019. We retrospectively collected and analyzed all cases underwent optical microscopy and immunohistochemical staining examinations, aiming to summarize and analyze the clinicopathologic features of them.

To the Editor:We were interested in the article, which reported a woman with calcinosis, Raynaud’s phenomenon, esophageal dysmotility, sclerodactyly and telangiectasia (CREST) syndrome who developed progressive dyspnea on exertion and was later diagnosed with pulmonary capillary hemangiomatosis (PCH) that was confirmed by an open lung biopsy.^[1]We would like to remark that the diagnosis of PCH is inconclusive from just history, treatment, and histological changes. This case also does not specify a clear connection between PCH and CREST syndrome; therefore, we believe we need to explore another possible disease association.

To the Editor:The Qinghai-Tibet Plateau, called the roof of the world, is an extremely harsh environment with scarce medical resources.^[1]After the founding of the People’s Republic of China, the Chinese government has invested a lot of financial support to develop Tibet Autonomous Region and to improve the quality of healthcare. The life expectancy of the whole district has increased from 36 years old in the 1950s to 68 years old currently, and the population has grown from less than 1 million in the 1950s to 3.31 million today.

To the Editor: Angiostrongylus cantonensisis one of the major causes of eosinophilic meningitis/meningoencephalitis, due to eating raw or undercooked paratenic or intermediate hosts like mollusks. Here, we described a case of combined infection ofA. cantonensisand herpes simplex virus type 1 (HSV-1) based on the results of next-generation sequencing (NGS).

To the Editor:Schwannomas, which are benign tumors derived from Schwann cells, are common soft-tissue tumors. However, schwannomas in children are rare.^[1]Furthermore, the imaging findings of some cases of pediatric schwannomas can be similar to those of hemangioblastomas, which makes them easily misdiagnosed. We reported a case of a pediatric schwannoma in the foramen magnum which was misdiagnosed as a hemangioblastoma before surgery.