2021年 · 第134卷第08期

Thoracic endovascular aortic repair (TEVAR) is the first choice of type B aortic dissection (TBAD).^[1,2,3]However, when the dissection involves an aortic arch with close proximity to the supra-aortic branches, the situation becomes complicated and challenging for classical TEVAR. In recent years, the Hybrid-ENDO vascular-Open arch repair (HENDO) theory that consists of some treatment strategies specifically for aortic arch lesions, becomes popular. Based on the HENDO theory, the modified endovascular technique, simultaneously aiming at the reconstruction of the involved supra-aortic branches and coverage of TBAD, is the first choice with promising future development. According to the specific anatomic situation and the pathology of the disease, hybrid or open surgery can be performed selectively.

Axillary lymph node assessment is one of the important indicators in the clinical pathological staging of breast cancer. Studies have shown that sentinel lymph node biopsy (SLNB) has the advantages of fewer complications and less trauma than conventional axillary lymph node dissection (ALND).^[1]Common mapping methods for SLNB include blue dye, radioisotopes, a combination of blue dye and radioisotopes, and fluorescence imaging. To standardize the SLNB techniques for breast cancer, the Chinese Society of Breast Surgery (CSBrS) re-evaluated the quality of evidence for clinical studies of SLNB for breast cancer, referring to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE), and developed the Clinical Practice Guidelines for Sentinel Lymph Node Biopsy in Patients with Early-Stage Breast Cancer: CSBrS Practice Guidelines 2021, in accordance with the Expert Consensus and Technical Operational Guidelines for Sentinel Lymph Node Biopsy guided by blue dye alone in Early Breast Cancer (2018) combined with data from clinical practice in breast surgery in China, providing a reference for breast surgeons in clinical practice in China.

The proportion of patients with early-stage breast cancer undergoing mastectomy exceeds 70% in China,^[1]among which Auchincloss operation is the major surgical technique for patients with axillary lymph node positive breast cancer. In order to standardize the clinical application of modified radical mastectomy of breast cancer, Chinese Society of Breast Surgery (CSBrS) organized domestic experts to conduct literature retrieval and expert discussion on the theoretical basis and technical details of modified radical mastectomy for breast cancer. With reference to the grading of recommendations assessment, development, and evaluation system, the related evidence was evaluated. Combined with the clinical accessibility, CSBrS breast cancer modified radical practice guidelines were developed to provide reference for the clinical practice of breast surgeons at home.

Previous studies have shown that the autonomic nervous system plays a role in the occurrence and development of gastric cancer (GC).^[1,2,3]Sympathetic and parasympathetic nerve fibers constitute a network in gastric wall submucosa and muscularis to control gastric peristalsis and secretion. These two groups of nerve fibers antagonize and coordinate with each other under the regulation of the central nervous system to complete their innervation function. Currently, most of the studies on the autonomic nervous system and GC focus on a single species nerve fiber or transmitter. The present study aimed to elucidate how the sympathetic and parasympathetic nervous systems antagonize and coordinate in the occurrence and development of GC. Simultaneously, some gastrointestinal hormones are also identified in the development of GC as helpers or tools of the sympathetic or parasympathetic nervous system.

A pandemic is a disease that spreads worldwide. When disease is new such as coronavirus disease 2019 (COVID-19), evidentiary basis, by definition, to prevent, diagnose, and treat the disease is limited. Nevertheless, clinical practice guidelines are urgently required to assist policy and healthcare workers to make informed decisions. But, acting in the high-quality evidentiary vacuum, that is, basing guidelines on poor-quality research can be counterproductive and potentially harmful.^[1,2]Thus, guideline developers face a number of challenges during a pandemic like COVID-19 that we wish to address in this paper.

Although endovascular therapy has been widely used for focal aortoiliac occlusive disease (AIOD), its performance for extensive AIOD (EAIOD) is not fully evaluated. We aimed to demonstrate the long-term results of EAIOD treated by endovascular therapy and to identify the potential risk factors for the loss of primary patency.

Between January 2008 and June 2018, patients with a clinical diagnosis of the 2007 TransAtlantic Inter-Society Consensus II (TASC II) C and D AIOD lesions who underwent endovascular treatment in our institution were enrolled. Demographic, diagnosis, procedure characteristics, and follow-up information were reviewed. Univariate analysis was used to identify the correlation between the variables and the primary patency. A multivariate logistic regression model was used to identify the independent risk factors associated with primary patency. Five- and 10-year primary and secondary patency, as well as survival rates, were calculated by Kaplan-Meier analysis.

A total of 148 patients underwent endovascular treatment in our center. Of these, 39.2% were classified as having TASC II C lesions and 60.8% as having TASC II D lesions. The technical success rate was 88.5%. The mean follow-up time was 79.2 ± 29.2 months. Primary and secondary patency was 82.1% and 89.4% at 5 years, and 74.8% and 83.1% at 10 years, respectively. The 5-year survival rate was 84.2%. Compared with patients without loss of primary patency, patients with this condition showed significant differences in age, TASC II classification, infrainguinal lesions, critical limb ischemia (CLI), and smoking. Multivariate logistic regression analysis showed age <61 years (adjusted odds ratio [aOR]: 6.47; 95% CI: 1.47-28.36; P = 0.01), CLI (aOR: 7.81; 95% CI: 1.92-31.89; P = 0.04), and smoking (aOR: 10.15; 95% CI: 2.79-36.90; P < 0.01) were independent risk factors for the loss of primary patency.

Endovascular therapy was an effective treatment for EAIOD with encouraging patency and survival rate. Age <61 years, CLI, and smoking were independent risk factors for the loss of primary patency.

Cumulative blood pressure (BP), a measure incorporating the level and duration of BP exposure, is associated with the risk of cardiovascular disease (CVD). However, the level at which cumulative BP could significantly increase the risk remains unclear. This study aimed to investigate the association of 15-year cumulative BP levels with the long-term risk of CVD, and to examine whether the association is independent of BP levels at one examination.

Data from a 26-year follow-up of the Chinese Multi-provincial Cohort Study-Beijing Project were analyzed. Cumulative BP levels between 1992 and 2007 were calculated among 2429 participants free of CVD in 2007. Cardiovascular events (including coronary heart disease and stroke) occurring from 2007 to 2018 were registered. Adjusted hazard ratios (HRs) for CVD incidence associated with quartiles of cumulative systolic blood pressure (SBP) and diastolic blood pressure (DBP) were calculated.

Of the 2429 participants, 42.9% (1042) were men, and the mean age in 2007 was 62.1 ± 7.9 years. Totally, 207 CVD events occurred during the follow-up from 2007 to 2018. Participants with higher levels of cumulative SBP or DBP exhibited a higher incidence rate of CVD (P < 0.001). Compared with the lowest quartile of cumulative SBP, the HR for CVD was 1.03 (95% confidence interval [CI]: 0.59-1.81), 1.69 (95% CI: 0.99-2.87), and 2.20 (95% CI: 1.21-3.98) for the second to the fourth quartile of cumulative SBP, and 1.46 (95% CI: 0.86-2.48), 1.99 (95% CI: 1.18-3.35), and 2.08 (95% CI: 1.17-3.71) for the second to the fourth quartile of cumulative DBP, respectively. In further cross-combined group analyses with BP measurements in 2007, 15-year cumulative BP levels higher than the median, that is, 1970.8/1239.9 mmHg·year for cumulative SBP/DBP, which were equivalent to maintaining SBP/DBP levels of 131/83 mmHg or above on average in 15 years, were associated with higher risk of CVD in subsequent years independent of BP measurements at one-time point.

Cumulative exposure to moderate elevation of BP is independently associated with increased future cardiovascular risk.

Acute type A aortic dissection (ATAAD) and acute type A intramural hematoma (ATAIMH) are life-threatening diseases with high mortality. To better understand their clinical features in the Chinese population, we analyzed the data from the first Registry of Aortic Dissection in China (Sino-RAD) to promote the understanding and management of the diseases.

All patients with ATAAD and ATAIMH enrolled in Sino-RAD from January 1, 2012 to December 31, 2016 were involved. The data of patients’ selection, history, symptoms, management, outcomes, and postoperation complications were analyzed in the study. The continuous variables were compared using the Student’s t test for normal distributions and the Mann-Whitney U test for non-normal distributions. Categorical variables were compared using the Chi-square test or Fisher exact test.

A total of 1582 patients with ATAAD and 130 patients with ATAIMH were included. The mean age of all patients was 48.4 years. Patients with ATAAD were significantly younger than patients with ATAIMH (48.9 years vs. 55.6 years, P < 0.001). For the total cohort, males were dominant, but the male ratio of patients with ATAAD was significantly higher compared to those with ATAIMH (P = 0.01). The time range from the onset of symptom to hospitalization was 2.0 days. More patients of ATAIMH had hypertension than that of ATAAD (82.3% vs. 67.6%, P < 0.05). Chest and back pain were the most common clinical symptoms. Computerized tomography (CT) was the most common initial diagnostic imaging modality. 84.7% received surgical treatment and in-hospital mortality was 5.3%. Patients with ATAAD mainly received surgical treatment (89.6%), while most patients with ATAIMH received medical treatment (39.2%) or endovascular repair (35.4%).

Our study suggests that doctors should comprehensively use clinical examination and genetic background screening for patients with ATAAD and ATAIMH and further shorten the time range from symptoms onset to intervention, achieving early diagnosis and treatment, thereby reducing the mortality rate of patients with aortic dissection in China. We should standardize the procedures of aortic dissection treatment and improve people’s understanding. Meanwhile, the curing and transferring efficiency should also be improved.

Since 2019, a novel coronavirus named 2019 novel coronavirus (2019-nCoV) has emerged worldwide. Apart from fever and respiratory complications, acute kidney injury has been observed in a few patients with coronavirus disease 2019. Furthermore, according to recent findings, the virus has been detected in urine. Angiotensin-converting enzyme II (ACE2) has been proposed to serve as the receptor for the entry of 2019-nCoV, which is the same as that for the severe acute respiratory syndrome. This study aimed to investigate the possible cause of kidney damage and the potential route of 2019-nCoV infection in the urinary system.

We used both published kidney and bladder cell atlas data and new independent kidney single-cell RNA sequencing data generated in-house to evaluate ACE2 gene expression in all cell types in healthy kidneys and bladders. The Pearson correlation coefficients between ACE2 and all other genes were first generated. Then, genes with r values larger than 0.1 and P values smaller than 0.01 were deemed significant co-expression genes with ACE2.

Our results showed the enriched expression of ACE2 in all subtypes of proximal tubule (PT) cells of the kidney. ACE2 expression was found in 5.12%, 5.80%, and 14.38% of the proximal convoluted tubule cells, PT cells, and proximal straight tubule cells, respectively, in three published kidney cell atlas datasets. In addition, ACE2 expression was also confirmed in 12.05%, 6.80%, and 10.20% of cells of the proximal convoluted tubule, PT, and proximal straight tubule, respectively, in our own two healthy kidney samples. For the analysis of public data from three bladder samples, ACE2 expression was low but detectable in bladder epithelial cells. Only 0.25% and 1.28% of intermediate cells and umbrella cells, respectively, had ACE2 expression.

This study has provided bioinformatics evidence of the potential route of 2019-nCoV infection in the urinary system.

Coronavirus disease 2019 (COVID-19), which is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has rapidly spread throughout the world. In this study, we aimed to identify the risk factors for severe COVID-19 to improve treatment guidelines.

A multicenter, cross-sectional study was conducted on 313 patients hospitalized with COVID-19. Patients were classified into two groups based on disease severity (nonsevere and severe) according to initial clinical presentation. Laboratory test results and epidemiological and clinical characteristics were analyzed using descriptive statistics. Univariate and multivariate logistic regression models were used to detect potential risk factors associated with severe COVID-19.

A total of 289 patients (197 nonsevere and 92 severe cases) with a median age of 45.0 (33.0, 61.0) years were included in this study, and 53.3% (154/289) were male. Fever (192/286, 67.1%) and cough (170/289, 58.8%) were commonly observed, followed by sore throat (49/289, 17.0%). Multivariate logistic regression analysis suggested that patients who were aged ≥ 65 years (OR: 2.725, 95% confidence interval [CI]: 1.317-5.636; P = 0.007), were male (OR: 1.878, 95% CI: 1.002-3.520, P = 0.049), had comorbid diabetes (OR: 3.314, 95% CI: 1.126-9.758, P = 0.030), cough (OR: 3.427, 95% CI: 1.752-6.706, P < 0.001), and/or diarrhea (OR: 2.629, 95% CI: 1.109-6.231, P = 0.028) on admission had a higher risk of severe disease. Moreover, stratification analysis indicated that male patients with diabetes were more likely to have severe COVID-19 (71.4% vs. 28.6%, χ² = 8.183, P = 0.004).

The clinical characteristics of those with severe and nonsevere COVID-19 were significantly different. The elderly, male patients with COVID-19, diabetes, and presenting with cough and/or diarrhea on admission may require close monitoring to prevent deterioration.

Recently, T-helper 17 (Th17) cells have been proved to play an important role in promoting cervical cancer. But, till now, few study has been carried out to understand the involvement of these cells in efficacy of anti-tumor treatments. This study aimed to investigate the alterations in the percentage of circulating Th17 cells and related cytokines in locally advanced cervical cancer (LACC) patients before and after concurrent chemoradiotherapy (cCRT) and to analyze the correlations between the alterations in Th17 cells and treatment efficacy.

A prospective study with 49 LACC (International federation of gynecology and obstetrics [FIGO] stage IIB-IIIB) patients and 23 controls was conducted. Patients received the same cCRT schedule and were followed up for 3 years. Circulating Th17 cells (CD3+CD8- interleukin [IL]-17+ T cells) and related cytokines IL-17, transforming growth factor-β (TGF-β), IL-10, IL-23, IL-6, and IL-22 were detected before and after cCRT. Correlations between alterations of circulating Th17 cells and treatment efficacy were analyzed. Kaplan-Meier analysis was used for overall survival (OS) and progression-free survival (PFS).

We found that 40 patients finished the entire cCRT schedule and met the endpoint of this study. The percentage of circulating Th17 cells in the LACC patients was higher than that in the controls, and it significantly decreased after cCRT (P < 0.05). After cCRT, patients were divided into two groups based on the average of the Th17 cells declined. The subgroup of patients with a prominent decrease in circulating Th17 cells after cCRT had a higher treatment efficacy and longer PFS and OS times. Compared with the control patients, LACC patients had higher IL-6, IL-10, IL-22, TGF-β levels and a lower IL-23 level (P < 0.05). After cCRT, IL-6, IL-10, IL-17, IL-23 level significantly increased and TGF-β level significantly decreased compared with the levels before cCRT (P < 0.05).

Circulating Th17 cells in the LACC patients (FIGO stage IIB-IIIB) were higher than those in the controls, but they generally decreased after cCRT. A more pronounced decrease in circulating Th17 cells after cCRT was correlated with better therapeutic effect and longer PFS and OS times.

Histone deacetylase 4 (HDAC4) regulates chondrocyte hypertrophy and bone formation. The aim of the present study was to explore the effects of HDAC4 on Interleukin 1 beta (IL-1β)-induced chondrocyte extracellular matrix degradation and whether it is regulated through the WNT family member 3A (WNT3A)/β-catenin signaling pathway.

Primary chondrocytes (CC) and human chondrosarcoma cells (SW1353 cells) were treated with IL-1β and the level of HDAC4 was assayed using Western blotting. Then, HDAC4 expression in the SW1353 cells was silenced using small interfering RNA to detect the effect of HDAC4 knockdown on the levels of matrix metalloproteinase 3 (MMP3) and MMP13 induced by IL-1β. After transfection with HDAC4 plasmids, the overexpression efficiency was examined using Real-time quantitative polymerase chain reaction (qRT-PCR) and the levels of MMP3 and MMP13 were assayed using Western blotting. After incubation with IL-1β, the translocation of β-catenin into the nucleus was observed using immunofluorescence staining in SW1353 cells to investigate the activation of the WNT3A/β-catenin signaling pathway. Finally, treatment with WNT3A and transfection with glycogen synthase kinase 3 beta (GSK3β) plasmids were assessed for their effects on HDAC4 levels using Western blotting.

IL-1β downregulated HDAC4 levels in chondrocytes and SW1353 cells. Furthermore, HDAC4 knockdown increased the levels of MMP3 and MMP13, which contributed to the degradation of the extracellular matrix. Overexpression of HDAC4 inhibited IL-1β-induced increases in MMP3 and MMP13. IL-1β upregulated the levels of WNT3A, and WNT3A reduced HDAC4 levels in SW1353 cells. GSK-3β rescued IL-1β-induced downregulation of HDAC4 in SW1353 cells.

HDAC4 exerted an inhibitory effect on IL-1β-induced extracellular matrix degradation and was regulated partially by the WNT3A/β-catenin signaling pathway.

Thoracic endovascular aortic repair (TEVAR) has been gradually considered as the mainstream therapy for type B aortic dissection (TBAD), especially for complicated acute TBAD,^[1]due to its minimally invasive nature and satisfactory clinical outcomes. Currently, our knowledge of aortic dissection and endovascular treatment is primarily derived from western registries including the International Registry of Acute Aortic Dissection (IRAD) and Vascular Quality Initiative (VQI), which includes few Asian TBAD patients without any Chinese population. Therefore, we report a long-term single-center experience of TBAD patients who underwent TEVAR in a Chinese high-volume tertiary center. The preliminary results would provide useful insight and enhances our understanding of this disease in the Chinese population.

Pectus excavatum (PE) is one of the most common congenital chest wall deformities observed in clinical practice and has an estimated prevalence in the range of one in 500 to one in 1000 among children; it is characterized by posterior displacement of the inferior sternum and the cartilaginous-rib attachments.^[1]The physiological symptoms and impairment which arise due to PE vary, as the depression of the anterior chest wall compresses the right heart chambers, causing various morphological and functional cardiac alterations. Some patients with PE experience progressive worsening of cardiopulmonary function with increasing age.^[2]Therefore, surgical repair aimed at correcting the disorder is strongly recommended.^[1,3]Several studies demonstrated an improvement in pulmonary function and exercise capacity in patients with PE after surgical repair.^[3,4,5]However, since the shape of the right ventricle (RV) is irregular and the function is difficult to assess using two-dimensional (2D) transthoracic echocardiography (TTE), the availability of cardiac benefits, especially RV function improvement, of surgical repair for PE deformity remains controversial according to previous studies that assessed RV function using 2D TTE.^[4,5]In contrast, three-dimensional (3D) TTE demonstrates better visualization and localization of the RV and can evaluate RV function more accurately.^[6,7]Therefore, we used 3D TTE to evaluate RV function before and after surgery in a group of patients who underwent surgical repair, to confirm the effects of PE deformity and improvements in RV structure and function after surgical correction.

Currently, transcatheter aortic valve implantation (TAVI) has become a feasible interventional technique for severe aortic stenosis in patients who deemed inoperable or are at high surgical risk. In China, the TAVI technique started from 2010. Until now two domestic devices J Valve (Jie Cheng Medical Technologies, Suzhou, China) and Venus A-Valve (Venus MedTech, Hangzhou, China) have been allowed access into the market in 2017, since then most centers began to set up TAVI programs. Venus A-Valve is the only transfemoral transcatheter valve in China which approximately has been implanted 4000 times, till VitaFlow (MicroPort, Shanghai, China) and SAPIEN 3 (Edwards Lifesciences, Irvine, CA, USA) entered the market in China a few months ago.

Type A dissection involving the aortic arch remains an inherently lethal condition. Sunet al^[1]recommended total arch replacement combined with stented elephant trunk implantation as a new "standard" therapy for type A dissection involving repair of the aortic arch. Cannulation of the right axillary artery is used for cardiopulmonary bypass (CPB) and selective cerebral perfusion in this procedure.^[1]However, this procedure may not be applied in some special cases, such as aberrant right subclavian arteries, serious involvement of the right subclavian artery, serious involvement of the right common carotid artery, and acute pericardial tamponade. The branch-first aortic arch replacement technique can adequately solve these problems. We analyzed the surgical data and midterm follow-up outcomes of this technique.

Ventricular septal rupture (VSR) is a rare but lethal complication of acute myocardial infarction (AMI).^[1]Emergent repair surgery provides the only chance for survival for patients with VSR; however, the perioperative mortality rate remains extremely high at the early phase.^[2]Elective surgery is widely utilized in real-world clinical practice and is associated with improved prognosis.^[3]Nevertheless, the results of elective surgery might be a manifestation of survival bias, as it is usually performed in relatively stable patients with VSR who are expected to survive the early stage and have a better prognosis than patients complicated with hemodynamic instability in the early stage.^[4]In this study, we aimed to present a novel surgical repair technique that can be safely, feasibly, and effectively used in hemodynamically unstable patients with VSR in the acute phase and to report the preliminary results.

Laryngopharyngeal reflux disease (LPRD) is currently defined as an inflammatory condition of the upper aerodigestive tract tissues related to the direct and indirect effects of gastroduodenal content reflux, which may induce morphologic changes in the upper aerodigestive tract.^[1]The pH of gastric contents is lower, which mainly causes acid reflux, while the pH of duodenal contents is higher than that of gastric contents, which can cause weakly acid reflux or alkaline reflux. Because carbonic anhydrase in the esophageal mucosa can convert CO₂, a product of cell metabolism, into bicarbonate, which plays a role in neutralizing gastric acid. Therefore, part of gastric acid reflux or duodenal contents reflux has a pH of less than 4 at the distal esophagus, but when it reaches the hypopharynx, the pH is greater than 4 and is converted to weakly acid or alkaline reflux. Therefore, using 24-h multichannel intraluminal impedance-pH (MII-pH) monitoring, laryngopharyngeal reflux (LPR) events are divided into the following categories according to the difference of pH in hypopharynx^[2]: (1) Acid LPR when pH was ≤4; (2) Weakly acid LPR when pH was 4 to 7; (3) Alkaline LPR when pH above 7. Both weakly acid and alkaline LPR were called non-acid reflux. According to the pH value of the distal esophagus and hypopharynx, non-acid reflux can be further divided into true non-acid reflux (pH >4 in both the distal esophagus and hypopharynx) and false non-acid reflux (pH ≤4 in the distal esophagus, but pH >4 in the hypopharynx) [Figure 1]. However, for each patient, the proportion of the true non-acid, false non-acid, and acid reflux of the LPR events is helpful to the develop a treatment plan. If true non-acid reflux events accounts for the majority of LPR events, then acid suppressive therapy is not the main one. If false non-acid reflux and acid reflux are dominant, then acid suppressive therapy is still very important. However, there are few studies on this classification of proportion in the literature, so we aimed to analyze the 24-h MII-pH data of 50 patients with suspected LPRD in order to understand the proportion of all kinds of LPR, which may be helpful to make the treatment plan of LPRD.

To the Editor: Fungal keratitis is primarily caused by pathogenic fungi species, such asFusarium solaniandAspergillus fumigatus. The incidence ofA. fumigatushas been increased worldwide.^[1]Although new therapies have been used for fungal keratitis, the efficacy of antifungal drugs remains unsatisfactory at present.^[2]Fungal keratitis is still a challenge for ophthalmologists because of its difficult and delayed diagnosis, as well as the lack of effective drugs and treatment.

To the Editor: Mirizzi syndrome (MS) is a rare type of cholelithiasis with an incidence of 0.1% in all gallstone cases.^[1]Its clinical manifestations and imaging features can sometimes be difficult to distinguish from those of choledocholithiasis and biliary tumors. The traditional treatment for MS is usually surgery, including cholecystectomy, exploration of common bile duct plus T-tube drainage, and cholangiojejunostomy.^[2]There have even been reports of endoscopic therapies for MS in recent years, but it is technically difficult and non-feasible in cases where the stones get stuck in the Hartmann pouch.^[3]Here we report a case where the MS was downstaged via endoscopic modalities to avoid cholangiojejunostomy.

To the Editor:Solitary fibrous tumors (SFTs) are mesenchymal neoplasms and were first described in pleura, then subsequently found in extrapleural organs, such as peritoneum, lung, parotid gland, paranasal sinuses, orbit, skin, and intracranial areas.^[1]However, extrapleural SFTs are limited to isolated case reports. Because of the rarity of them, the related information is far from sufficient and thus, leading this tumor under fully recognized. According to the World Health Organization (WHO) classification, SFTs are pluripotent neoplasms that could be benign, intermediate, or malignant. All of above drive us to further understand the epidemiology, clinical characteristics, medical therapy, and prognosis of this disease.

To the Editor: For patients with acute DeBakey type I aortic dissection, ascending aortic or hemiarch replacement can reduce the surgical time and save lives in critical situations. However, residual distal dissection increases the risk of dilatation, rupture, and death.^[1]In contrast, total aortic arch replacement (TAR) with frozen elephant trunk (FET) implantation can minimize the need for re-intervention,^[2]but may increase the risk of operative mortality, stroke, paraplegia, and other complications. Currently, the question of the optimal surgical strategy for acute DeBakey type I aortic dissection remains controversial owing to the scarcity of long-term follow-up data and the technical diversities among different institutions. Therefore, in this study, we compared the early and long-term outcomes of limitedvs.extended repair in the management of patients with acute DeBakey type I aortic dissection.

To the Editor:Drug-eluting bead bronchial arterial chemoembolization (DEB-BACE) has been proven to be a feasible and well-tolerated treatment option for patients with non-small cell lung cancer (NSCLC) who are ineligible for or refuse to receive standard chemotherapy.^[1]Here, we report a rare complication of multiple cerebral embolic infarcts, mainly in the posterior cerebral circulation, in a patient with squamous cell lung cancer who was performed with DEB-BACE. To our knowledge, this complication has rarely been reported in patients with NSCLC undergoing DEB-BACE. Approval was obtained from our Institutional Review Board and patient for the publication of this case report.

To the Editor:Measurement of nuchal translucency (NT) is a validated marker for aneuploidy, fetal abnormalities, and other pathologic conditions,^[1]which makes it crucial to ensure the accuracy of NT measurement in clinical treatment. Ever since 2012, all the pregnant women visiting our hospital (The International Peace Maternity& Child Health Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, China) need to receive a routine first-trimester sonographic marker assessment. However, what is noticeably is that it is difficult to reach the standard section of every case and get accurate measurement data because of the time spent, the fetus position, the sonographers technique, and other factors. Even in the non-standard section, NT measurement is valuable in Prenatal Diagnostic Center. Therefore, the aim of this study was to assess the association between the adverse pregnancy outcome and the increased NT measurement, which will help with the counseling of women in our setup, thereby reducing birth defects.

To the Editor: The global pandemic of coronavirus disease 2019 (COVID-19) is not under control, and COVID-19 has affected tens of millions of people worldwide. Although the main features of COVID-19 are diffuse alveolar damage and acute respiratory failure, damage to other organs is also of concern because these patients tend to have more severe symptoms and worse prognosis. In this article, we briefly review the characteristics of kidney involvement in COVID-19 and the impact of kidney injury on prognosis of the disease, in order to better understand the COVID-19 epidemic from the perspective of a nephrologist.

To the Editor:The coagulation system is a complex regulatory system in the human body. In this case, the young patient had various vital thrombosis, including cerebral venous sinus thrombosis (CVST), coronary thrombosis, and left ventricular thrombus. However, the patient had neither hypercoagulable-related diseases nor risks nor coagulative or fibrinolytic protein deficiency.^[1]Further genetic testing did not show the usual gene mutations relevant to coagulation dysfunction. We report such a patient with a slight elevation in coagulation FVIII activity and a rareFVIIIgene duplication.

To the Editor:Anti-melanoma differentiation-associated gene 5 (MDA-5) positive interstitial lung disease (ILD) is featured by rapidly progressing respiratory failure and limited hospital survival. No standard therapy has been established or proven to be beneficial. Herein, we report a case of a rapidly progressing patient diagnosed of ILD with positive anti-MDA-5 antibody receiving tocilizumab treatment.