Volume 133 · Issue 06 · 2020

Aberrant activation of the complement system plays an important role in the pathogenesis and development of immunoglobulin A nephropathy (IgAN). The relationship between serum complement and the clinical-histopathological features and outcomes of IgAN is controversial. This retrospective study aimed to examine the relationship between the complement 3/4 (C3/C4) ratio and the clinicopathologic changes and prognosis of patients with IgAN.

A total of 397 patients with primary IgAN from January 2007 to December 2012 at the Chinese People’s Liberation Army General Hospital were included in this study. The correlation test and Chi-square test or one-way analysis of variance test were performed to evaluate the relationship between the C3/C4 ratio and other clinical-pathological factors. Propensity score matching and a multivariate Cox regression model were used to calculate the risk factors of renal outcome.

The median follow-up period was 75 months. During the follow-up period, 62 patients (15.6%) developed into the end-stage renal disease (ESRD). The C3/C4 ratio at baseline was associated with the level of serum creatinine (SCr), 24 h urinary protein excretion (24 h Upre), global glomerular sclerosis, and tubulointerstitial lesion. The level of SCr and 24 h Upre and the degree of chronic kidney injury were statistically different among groups defined by different C3/C4 ratio levels. The survival rates of patients among groups with different C3/C4 ratio levels were different. After propensity score matching, eighty-eight pairs of patients were successfully matched, and the C3/C4 ratio was an influencing factor for the patients’ outcome (hazard ratio 0.587, 95% confidence interval 0.329-0.880). Patients with a C3/C4 ratio <3.6 had a poorer outcome compared with the others (P = 0.002).

IgAN patients with decreased C3/C4 ratio displayed significantly more severe clinical symptoms and chronic renal injury than patients with higher ratios. A low C3/C4 ratio could be a risk factor for patients developing to ESRD.

Cell salvage has recently been recommended for obstetric use in cases with a high risk of massive hemorrhage during cesarean section (CS). However, limited data are available to support the use of one suction device to collect lost blood. This study aimed to investigate the volume of red blood cells (RBCs) salvaged and the components of amniotic fluid (AF) in blood salvaged by one suction device or two devices during CS in patients with placenta previa and/or accrete.

Thirty patients with placenta previa and/or accrete undergoing elective CS in the Women’s Hospital of Zhejiang University School of Medicine were recruited for the present study from November 1, 2017 to December 1, 2018. The patients were randomly assigned to one of the two groups according to an Excel-generated random number sheet: Group 1 (n = 15), in which only one suction device was used to aspirate all blood and AF, and Group 2 (n = 15), in which a second suction device was mainly used to aspirate AF before the delivery of the placenta. Three samples of blood per patient (pre-wash, post-wash, and post-filtration) were collected to measure AF components. The salvaged RBC volumes were recorded. Continuous data of pre-wash, post-wash, and postfiltration samples were analyzed by using one-way analysis of variance with Tukey’s test for multiple comparisons, or Kruskal-Wallis test with Dunn test for multiple comparisons. Comparisons of continuous data between Group 1 and Group 2 were conducted using Student’s t test or Mann-Whitney U test.

The salvaged RBC volume was significantly higher in Group 1 than that in Group 2 (401.6 ± 77.2 mL vs. 330.1 ± 53.3 mL, t = 4.175, P < 0.001). In both groups, squamous cells, lamellar bodies, and fat were significantly reduced by washing (all P<0.001) and squamous cells were further reduced by filtering (P < 0.001). Squamous cells were found in six post-filtration samples (three from each group). Lamellar bodies and fat were completely removed by filtering. Insulin-like growth factor binding protein 1, alphafetoprotein, albumin, lactate dehydrogenase, and potassium were significantly reduced post-wash (all P < 0.05), with no further significant reduction after filtration in either group (all P > 0.05). The mean percentage of fetal RBCs post-filtration was (1.8 ± 0.8)% with a range of 1.0% to 3.5% and (1.9 ± 0.9)% with a range of 0.7% to 4.0% in Groups 1 and 2, respectively, showing no significant difference between the two groups (U= 188.5, P = 0.651).

Cell salvage performed by one suction device could result in higher volume of salvaged RBCs and can be used safely for CS in patients with placenta previa and/or accrete when massive hemorrhage occurs.

Clinically amyopathic dermatomyositis (CADM) is a unique sub-type of idiopathic inflammatory myopathies with a high prevalence of interstitial lung disease (ILD). Poor prognosis of the patients was strongly associated with rapid progressive ILD. The aim of this study was to identify risk factors for prediction of different types of ILD in CADM.

In this study, data of 108 inpatients with CADM were collected, including 87 with ILD. The baseline clinical data and laboratory parameters, including myositis-specific and associated antibodies and tumor-associated antigens were analyzed to identify risk factors for acute or subacute interstitial pneumonitis (A/SIP) and chronic interstitial pneumonitis (CIP).

In 87 patients with CADM-ILD, 39 (36.1%) were A/SIP, and 48 (44.4%) were CIP. There were 22 (20.4%) patients with asymptomatic ILD who were detected by routine high resolution computed tomography. Cytokeratin-19 fragment (CYFRA21-1) was significantly higher in CADM-ILD than that in CADM patients without ILD; carcinoembryonic antigen and neuron-specific enolase were significantly elevated in A/SIP than that in CIP. Patients with A/SIP had a higher positive rate of anti-melanoma differentiation-associated gene 5 (MDA5), while patients with CIP had a higher positive rate of anti PL-12 and anti-Ro-52. Logistic regression analysis indicated that elevation of CYFRA21-1 was a risk factor for ILD, higher titer of anti-MDA5 indicated increased likelihood for A/SIP, and higher titer of anti-Ro-52 was also clearly associated with CIP.

This study indicated that the prevalence of ILD was high in CADM. Asymptomatic ILD has been previously underestimated. Anti-MDA5 was a risk factor for the presence of A/SIP, and CYFRA21-1 was a risk factor for ILD.

Intravertebral and general anesthesia (GA) are two main anesthesia approaches but both have defects. This study was aimed to evaluate the effect of subarachnoid anesthesia combined with propofol target-controlled infusion (TCI) on blood loss and transfusion for total hip arthroplasty (THA) in elderly patients in comparison with combined spinal-epidural anesthesia (CSEA) or GA.

Totally, 240 patients (aged ≥65 years, American Society of Anesthesiologists [ASA] I-III) scheduled for posterior THA were enrolled from September 1st, 2017 to March 1st, 2018. All cases were randomly divided into three groups to receive CSEA (group C, n = 80), GA (group G, n = 80), or subarachnoid anesthesia and propofol TCI (group T, n= 80), respectively. Primary outcomes measured were intra-operative blood loss, autologous and allogeneic blood transfusion, mean arterial pressure at different time points, length of stay in post-anesthesia care unit (PACU), length of hospital stay, and patient satisfaction degree. Furthermore, post-operative pain scores and complications were also observed. The difference of quantitative index between groups were analyzed by one-way analysis of variance, repeated measurement generalized linear model, Student-Newman-Keuls test or rank-sum test, while ratio index was analyzed by Chi-square test or Fisher exact test.

Basic characteristics were comparable among the three groups. Intra-operative blood loss in group T (331.53 ± 64.33 mL) and group G (308.03 ± 64.90 mL) were significantly less than group C (455.40 ± 120.48 mL, F = 65.80, P < 0.001). Similarly, the autologous transfusion of group T (130.99 ± 30.36 mL) and group G (124.09 ± 24.34 mL) were also markedly less than group C (178.31 ± 48.68 mL, F= 52.99, P < 0.001). The allogenetic blood transfusion of group C (0 [0, 100.00]) was also significantly larger than group T (0) and group G (0) (Z = 2.47, P = 0.047). Except for the baseline, there were significant differences in mean arterial blood pressures before operation (F= 496.84, P < 0.001), 10-min after the beginning of operation (F = 351.43, P < 0.001), 30-min after the beginning of operation (F = 559.89, P < 0.001), 50-min after the beginning of operation (F = 374.74, P < 0.001), and at the end of operation (F= 26.14, P < 0.001) among the three groups. Length of stay in PACU of group T (9.41 ± 1.19 min) was comparable with group C (8.83 ± 1.26 min), and both were significantly shorter than group G (16.55 ± 3.10 min, F = 352.50, P < 0.001). There were no significant differences among the three groups in terms of length of hospitalization and post-operative visual analog scale scores. Patient satisfaction degree of group T (77/80) was significantly higher than group C (66/80, χ²= 7.96, P = 0.004) and G (69/80, χ² = 5.01, P = 0.025). One patient complained of post-dural puncture headache and two complained of low back pain in group C, while none in group T. Incidence of post-operative nausea and vomiting in group G (10/80) was significantly higher than group T (3/80, χ² = 4.10, P = 0.043) and group C (2/80, χ² = 5.76, P = 0.016). No deep vein thrombosis or delayed post-operative functional exercise was detected.

Single subarachnoid anesthesia combined with propofol TCI seems to perform better than CSEA and GA for posterior THA in elderly patients, with less blood loss and peri-operative transfusion, higher patient satisfaction degree and fewer complications.

Mallet fracture is avulsion of the terminal extensor tendon from the base of the distal phalangeal bone with a bony fragment. This study was performed to evaluate the anatomical characteristics of mallet fractures, investigate a new mallet fracture classification system using anatomical and imaging methods, and discuss the treatment schemes for different types of mallet fracture.

Sixty-four fresh cadaveric fingers were divided into four groups, and models of different types of mallet fracture with distal interphalangeal joint instability were established by dissecting 25%, 50%, 75%, and 100% of the bilateral collateral ligaments. The effect of mallet fractures on the stability of the distal interphalangeal joint was then observed. The lateral radiographs of mallet fractures in 168 patients were analyzed and classified according to the involvement of the joint surface in the fracture, the thickness of fracture, the untreated time after injury, and the complication of distal interphalangeal joint palmar subluxation. Forty-seven patients were surgically treated by reconstruction of extensor tendon insertion, the Ishiguro method, or single Kirschner wire fixation.

The established mallet fracture model showed that the distal interphalangeal joint was stable when the bilateral collateral ligaments were cut off by 25% (t= -0.415, P = 0.684) and significantly unstable when this range was ≥50% (50% transection: t= -6.363, P < 0.001; 75% transection: t= -17.036, P < 0.001; 100% transection: t = -30.977, P < 0.001, respectively). The mallet fractures were divided into Types I, II, and III (fracture involving <20%, 20%-50%, and >50% of the joint surface, respectively). Type II was further divided into Types IIa and IIb according to whether the course of injury was < or ≥2 weeks, respectively. The mean post-operative flexion of the distal interphalangeal joint was 63.4° ± 7.9°, and the mean extension lag was 6.7°± 4.6°.

The lateral collateral ligament is the main factor that maintains the stability of the distal interphalangeal joint. Classification that combines the involvement of the joint surface in the fracture, the thickness of the fracture, and the untreated time after injury is reasonable and will help to choose an appropriate operational method.

Proliferative diabetic retinopathy (PDR) is a progressive stage of diabetic retinopathy featured by the formation of neovascular and proliferative membrane. Vascular endothelial growth factor (VEGF) acts as a pivot factor in the development of neovascularization. This study was to investigate the changes of intravitreal VEGF concentrations of severe PDR after intravitreal injection of conbercept (IVC) and its potential advantages to the following vitrectomy.

This was a prospective, interventional, randomized controlled study. Sixty eyes (60 patients) with severe PDR and 20 eyes from 20 patients with rhegmatogenous retinal detachment complicated with proliferative vitreoretinopathy were enrolled in this study. PDR eyes were randomly assigned to three groups by sortation randomization method with 20 eyes in each based on the interval of preoperative IVC (group A: 7 days, group B: 14 days, group C: non-IVC). Another 20 eyes without diabetes were enrolled as the non-diabetic control group (group D), receiving PPV directly. Vitreous specimens of all 80 patients were collected and evaluated afterwards. The intravitreal VEGF concentration of the four groups, and the total surgical time and the intraoperative bleeding rate of the PDR groups were recorded.

The mean intravitreal VEGF concentrations of groups A-D were 66.6 ± 43.3, 93.1 ± 52.3, 161.4 ± 106.1 and 1.8 ± 1.2 pg/mL, respectively. It increased significantly in PDR patients (groups A, B and C) (P = 0.002, <0.001, and <0.001, respectively). PDR patients with preoperative IVC (groups A and B) presented significantly lower VEGF concentrations (P < 0.001 and 0.001), intraoperative bleeding rates (P= 0.004) and total surgical time (P < 0.001, P= 0.003) compared with group C. No statistical differences were presented between groups A and B on the three parameters.

Seven days and 14 days of preoperative IVC are equally efficient and safe for the vitrectomy of severe PDR patients through decreasing vitreous VEGF concentrations, intraoperative bleeding rate and total surgical times.

In consideration of the difficulty in diagnosing high heterogeneous glioma, valuable prognostic markers are urgent to be investigated. This study aimed to verify that connective tissue growth factor (CTGF) is associated with the clinical prognosis of glioma, also to analyze the effect of CTGF on the biological function.

In this study, glioma and non-tumor tissue samples were obtained in 2012 to 2014 from the Department of Neurosurgery of Nanfang Hospital of Southern Medical University, Guangzhou, China. Based on messenger RNA (mRNA) data from the Cancer Genome Atlas (TCGA) and CCGA dataset, combined with related clinical information, we detected the expression of CTGF mRNA in glioma and assessed its effect on the prognosis of glioma patients. High expression of CTGF mRNA and protein in glioma were verified by reverse transcription-polymerase chain reaction, immunohistochemistry, and Western blotting. The role of CTGF in the proliferation, migration, and invasion of gliomas were respectively identified by methylthiazoletetrazolium assay, Transwell and Boyden assay in vitro. The effect on glioma cell circle was assessed by flow cytometry. For higher expression of CTGF in glioblastoma (GBM), the biological function of CTGF in GBM was investigated by gene ontology (GO) analysis.

In depth analysis of TCGA data revealed that CTGF mRNA was highly expressed in glioma (GBM, n= 163; lowly proliferative glioma [LGG], n = 518; non-tumor brain tissue, n = 207; LGG, t = 2.410, GBM, t = 2.364, P < 0.05). CTGF mRNA and protein expression in glioma (86%) was significantly higher than that in non-tumor tissues (18%) verified by collected samples. Glioma patients with higher expression of CTGF showed an obviously poorer overall survival (35.4 and 27.0 months compared to 63.3 and 55.1 months in TCGA and Chinese Glioma Genome Atlas (CGGA) databases separately, CGGA: χ² = 7.596, P = 0.0059; TCGA: χ² = 10.46, P = 0.0012). Inhibiting CTGF expression could significantly suppress the proliferation, migration, and invasion of gliomas. CTGF higher expression had been observed in GBM, and GO analysis demonstrated that the function of CTGF in GBM was mainly associated with metabolism and energy pathways (P < 0.001).

CTGF is highly expressed in glioma, especially GBM, as an unfavorable and independent prognostic marker for glioma patients and facilitates the progress of glioma.

Fibroblast-like synoviocytes (FLSs), resident mesenchymal cells of synovial joints, play an important role in the pathogenesis of rheumatoid arthritis (RA). Dickkopf-1 (DKK-1) has been proposed to be a master regulator of bone remodeling in inflammatory arthritis. Here, potential impairation on the activity of FLSs derived from RA to small interfering RNAs (siRNAs) targeting DKK-1 was investigated.

siRNAs targeting DKK-1 were transfected into FLSs of patients with RA. Interleukin (IL)-1β, IL-6, IL-8, matrix metalloproteinase (MMP) 2, MMP3, MMP9, transforming growth factor (TGF)-β1, TGF-β2 and monocyte chemoattractant protein (MCP)-1 levels in the cell culture supernatant were detected by enzyme-linked immunosorbent assay (ELISA). Invasion assay and ³H incorporation assay were utilized to investigate the effects of siRNAs targeting DKK-1 on FLSs invasion and cell proliferation, respectively. Western blotting was performed to analyze the expression of nuclear factor (NF)-κB, interleukin-1 receptor-associated kinase (IRAK)1, extracellular regulated protein kinases (ERK)1, Jun N-terminal kinase (JNK) and β-catenin in FLSs.

DKK-1 targeting siRNAs inhibited the expression of DKK-1 in FLSs (P < 0.01). siRNAs induced a significant reduction of the levels of IL-6, IL-8, MMP2, MMP3 and MMP9 in FLSs compared to the control group (P < 0.05). DKK-1 targeting siRNAs inhibited the proliferation and invasion of FLSs (P < 0.05). Important molecules of pro-inflammatory signaling in FLSs, including IRAK1 and ERK1, were decreased by the inhibition of DKK-1 in FLSs. In contrast, β-catenin, a pivotal downstream molecule of the Wnt signaling pathway was increased.

By inhibiting DKK-1, we were able to inhibit the proliferation, invasion and pro-inflammatory cytokine secretion of FLSs derived from RA, which was mediated by the ERK or the IRAK-1 signaling pathway. These data indicate the application of DKK-1 silencing could be a potential therapeutic approach to RA.

Machine learning shows enormous potential in facilitating decision-making regarding kidney diseases. With the development of data preservation and processing, as well as the advancement of machine learning algorithms, machine learning is expected to make remarkable breakthroughs in nephrology. Machine learning models have yielded many preliminaries to moderate and several excellent achievements in the fields, including analysis of renal pathological images, diagnosis and prognosis of chronic kidney diseases and acute kidney injury, as well as management of dialysis treatments. However, it is just scratching the surface of the field; at the same time, machine learning and its applications in renal diseases are facing a number of challenges. In this review, we discuss the application status, challenges and future prospects of machine learning in nephrology to help people further understand and improve the capacity for prediction, detection, and care quality in kidney diseases.

Epigenetic regulation includes changes of DNA methylation and modifications of histone proteins and is essential for normal physiologic functions, especially for controlling gene expression. Epigenetic dysregulation plays a key role in disease pathogenesis and progression of some malignancies, including acute myeloid leukemia (AML). Epigenetic therapies, including hypomethylating agents (HMAs) and histone deacetylase (HDAC) inhibitors, were developed to reprogram the epigenetic abnormalities in AML. However, the molecular mechanisms and therapeutic effects of the two agents alone or their combination remain unknown. An overview of these epigenetic therapies is given here. A literature search was conducted through PubMed database, looking for important biological or clinical studies related to the epigenetic regimens in the treatment of AML until October 15th, 2019. Various types of articles, including original research and reviews, were assessed, identified, and eventually summarized as a collection of data pertaining the mechanisms and clinical effects of HMAs and HDAC inhibitors in AML patients. We provided here an overview of the current understanding of the mechanisms and clinical therapeutic effects involved in the treatment with HMAs and HDAC inhibitors alone, the combination of epigenetic therapies with intensive chemotherapy, and the combination of both types of epigenetic therapies. Relevant clinical trials were also discussed. Generally speaking, the large number of studies and their varied outcomes demonstrate that effects of epigenetic therapies are heterogeneous, and that HMAs combination regimens probably contribute to significant response rates. However, more research is needed to explore therapeutic effects of HDAC inhibitors and various combinations of HMAs and HDAC inhibitors.

The regeneration capacity of cardiomyocytes (CMs) is retained in neonatal mouse hearts but is limited in adult mouse hearts. Myocardial infarction (MI) in adult hearts usually leads to the loss of large amounts of cardiac tissue, and then accelerates the process of cardiac remodeling and heart failure. Therefore, it is necessary to explore the potential mechanisms of CM regeneration in the neonates and develop potential therapies aimed at promoting CM regeneration and cardiac repair in adults. Currently, studies indicate that a number of mechanisms are involved in neonatal endogenous myocardial regeneration, including cell cycle regulators, transcription factors, non-coding RNA, signaling pathways, acute inflammation, hypoxia, protein kinases, and others. Understanding the mechanisms of regeneration in neonatal CMs after MI provides theoretical support for the studies related to the promotion of heart repair after MI in adult mammals. However, several difficulties in the study of CM regeneration still need to be overcome. This article reviews the potential mechanisms of endogenous CM regeneration in neonatal mouse hearts and discusses possible therapeutic targets and future research directions.

急性钡中毒在临床上并不常见。它主要是由于摄入可溶性钡化合物如BaCl而发生的₂这会导致胃肠炎（呕吐、腹泻和腹痛）、低钾血症、高血压、心律失常和骨骼肌麻痹。近期，我院附近发生了几起相关的因食品污染引起的钡中毒病例。我们展示了这些病例的数据，并描述了我们管理的一个代表性病例。

重度抑郁症（MDD）是一种普遍的、通常是慢性的、高度致残的多维精神疾病。^[1]此外，并发焦虑症状在MDD患者中极其常见；高达90%的患者出现焦虑症状。^[2]值得注意的是，高水平的焦虑症状可能预示着更差的临床结果，因为对MDD的药物治疗反应不佳。^[3]因此，在早期治疗过程中使用强化或联合策略可能是必要的，但由于缺乏评估初始治疗早期改善的共识，确保准确和及时的改变是困难的。迄今为止，重复的证据表明，缺乏早期改善（例如，<2周内抑郁量表评分降低20%）可以是识别最终无应答者的准确预测因素。^[4]本研究旨在评估MDD和高度焦虑患者抗抑郁作用的早期起效和临床结局，并探讨早期起效改善的潜在影响因素。

乳糜泻（CeD）是一种由谷蛋白在遗传易感个体中引发的自身免疫性肠病。^[1]CeD可能会出现典型的胃肠道症状，如慢性腹泻、腹胀和饮食中的麸质引发的体重增加不良。一些儿童可能以身材矮小（SS）为CeD的唯一表现。^[2]CeD报告了内分泌生长轴的短暂功能障碍。^[3]这种明显的生长激素缺乏症(GHD)通常随着无麸质饮食(GFD)的引入而正常化。

在过去的十年中，经皮肾镜取石术（PCNL）已经获得了显著的认可。使用的仪器的最小化和灵活的范围改进有助于导致它的流行。先前的文献证明，束大小与出血率和肾损伤呈正相关。^[1]基于这一概念，我们设计了一种新的PCNL技术，称为“针-perc”，因为针甚至比微-perc技术更薄。在本研究中，我们介绍了使用针-perc方法治疗小肾结石的初步经验，并评估了其作为微创腔内泌尿外科领域新器械的可行性和安全性。

致编辑：一名42岁的中国男子因短暂失去知觉而头部外伤，在户外骑自行车时被蜜蜂蜇伤鼻根后摔倒。被紧急送往急诊室后，他出现出汗、头晕、头痛、胸闷、气短和尿失禁。血压74/47mmHg，血氧饱和度81%，脉率149次/分。体格检查发现精神错乱，双侧瞳孔直径3 mm，瞳孔对光反射稍不敏感，腹部僵硬。立即给予25 mg异丙嗪和10 mg地塞米松。患者既往无心血管疾病史或相关危险因素。然而，他有蜜蜂蜇伤史，之前没有观察到明显的异常。心电图(ECG)显示窦性心动过速（152次/分），II-III期ST段压低，aVR期ST段抬高[图1A].超声心动图和胸部X线检查未见异常。实验室检查显示白细胞计数为17.06 × 10⁹/L（正常范围：3.5-9.5 × 10⁹/L），嗜酸性粒细胞计数0.73 × 10⁹/L（正常范围：0.02-0.52 × 10⁹/L），肌酸激酶-MB（CK-MB）水平为29.5 ng/L（正常范围：0-5 ng/L），心肌肌钙蛋白I水平为<0.5 ng/mL(正常范围：0-1ng/mL)，肌红蛋白水平为249.1 ng/mL(正常范围：0-70ng/mL)；其他各项指标均未见明显异常。患者接受了冠状动脉造影，但没有明显异常。皮肤科医生在会诊后进行了特异性免疫球蛋白E（S-IgE）测试[图1B]，表明树木组合（柳树/杨树/榆树）的S-IgE为11.4 kU/L（正常范围：0-0.35 kU/L）。给予抗过敏药物及输液后，患者病情好转，心电图及心肌酶异常恢复正常。医生建议病人避免接触过敏原。随访1年，患者无类似发作。

致编辑：常染色体显性多囊肾病（ADPKD）是一种常见的遗传性肾脏疾病，估计发病率为1/400至1/1000。^[1]它是一种迟发性全身性疾病，以肾脏中囊肿的发展和进行性增大为特征，最终导致终末期肾病。^[2]先前的研究表明，ADPKD是一种由两个基因突变导致的异质性单基因疾病：PKD1和PKD2临床数据显示PKD1和PKD2突变分别占ADPKD病例的85%和15%。^[3]相比PKD2突变，PKD1突变通常表明疾病更严重，发病更早，预后更差。^[4]没有突变热点PKD1和PKD2，表明突变不仅是单个家族独有的，而且是高度可变的。在本研究中，一个新的无义突变c.6491C>A（p.Ser 2164ter）和一个已知的移码突变c.12608_12635del（p.Arg 4203Profs*146）PKD1通过靶向下一代测序鉴定了两个中国ADPKD家系的基因。

致编辑：美容医学旨在通过帮助维护、改变和重塑他们的身体外观和美丽来为寻求美学之美的患者提供帮助。美容医学包括美容外科学、美容皮肤科、美容口腔医学、美容中医学、美容医学技术、美容保健技术、美容临床心理学、医学美容技法等。^[1]美容医学的所有分支都源于它们的母学科，并有共同的目标和宗旨。美容外科起源于整形、颌面、眼耳鼻喉、骨科，包括显微外科等。同样，美容皮肤科起源于皮肤科，美容牙科起源于口腔科。^[2]

致编辑：马蹄蟹是一种古老的海洋生物，属于节肢动物门。有三个属，鲎,快速性，和癌蝎子.^[1]阿米巴细胞裂解物是从鲎的阿米巴细胞中提取的冻干产物，被称为鲎阿米巴细胞裂解物（LAL）和快速性阿米巴细胞裂解物（TAL），广泛用于内毒素检测。由于职业暴露，从事内毒素评估的人有LAL或TAL过敏的风险。在此，我们描述了一例对TAL的职业过敏。

致编辑：急性-慢性肝功能衰竭（ACLF）是慢性肝病/肝硬化患者的一种综合征，其特征是肝功能急性恶化并伴有一个或多个肝外器官衰竭。^[1]ACLF可能导致28天死亡率增加，范围为23%至74%。^[2]影响ACLF病程的常见沉淀损伤包括病毒、药物、酒精、感染/败血症、胃肠道出血、缺血、手术和特发性损伤。^[1]关于碘化造影剂（ICM）暴露促进ACLF引发甲状腺毒症的病例报告很少。这里我们报告一个这样的案例。

致编辑：肝细胞癌（HCC）是全球第三大致命恶性肿瘤。^[1]除索拉非尼外，仑伐替尼是目前2018年获批的第二个一线治疗HCC的靶向药物。乐伐替尼是一种口服多激酶抑制剂，靶向血管内皮生长因子（VEGF）受体1至3、成纤维细胞生长因子受体1至4、血小板衍生生长因子受体α、RET和KIT。^[2]接受lenvatinib治疗的患者出现腹泻和脱发，以及更多的高血压、蛋白尿和甲状腺功能减退。在此，我们报告了两例发生不可逆胰腺萎缩的患者，这是lenvatinib的新不良事件。

致编辑：蜘蛛血管瘤是一种良性血管病变，多与失代偿期肝硬化有关。在这里，我们报告了一例慢性肝移植物抗宿主病（GVHD）患者的多发性蜘蛛血管瘤。

致编辑：根据世界卫生组织的数据，食管癌是全球第六大常见癌症。^[1]由于临床进展迅速，预后极差，食管鳞状细胞癌（ESCC）的5年生存率仍低于20%；^[2]因此，需要在该领域进一步发展。人乳头瘤病毒(HPV)是一种小的环状无包膜双链DNA病毒，主要感染粘膜和皮肤角质形成细胞^[3]其在ESCC的感染率在全球范围内为11.7%至38.9%。^[4]P16由CDKN2A基因，被称为细胞周期蛋白依赖性激酶抑制剂2A，是鳞状细胞癌中广泛使用的免疫组织化学标志物，与高危人乳头瘤病毒相关。^[5]

致编辑：许多疾病都伴有舞蹈病，如脑血管病、糖尿病和全身性自身免疫性疾病。舞蹈病的鉴别诊断很复杂，还有许多其他罕见的舞蹈病原因。半舞蹈症是一种单侧不自主运动的舞蹈症。在T1加权脑磁共振成像（MRI）上与非酮症高血糖和高信号强度病变相关的半舞蹈症被认为是糖尿病纹状体病（DS）。^[1]运动障碍和成像异常通常随着高血糖症的治疗而消退。因此，这种疾病现在很容易诊断，具有典型的特征。然而，伴有抗磷脂综合征（APS）的偏侧舞蹈症很少被报道，与DS相比，其临床特征和影像学表现更加多变。

致编辑：在科学引文索引（SCI）期刊上发表的文章对雇主和政府的声音比患者的感激更响亮的时代，“你的论文怎么样”已经成为中国年轻医生的新“你好”。^[1]尽管发表论文的压力意味着医生紧跟医学进步，也激发了批判性思维，^[2]这是手段，不是目的。我注意到同事们准备发表他们的文章的程度，包括进行无意义的实验，分析不相关的数据，写多余的评论。这在中国的医学研究生中尤其明显，他们被期望至少发表一篇论文来完成学业；然而，因为他们才刚刚开始他们的临床工作，他们实际上对他们最终的专业知之甚少。发表东西的意义大于内容。