Volume 133 · Issue 11 · 2020

The 2019 novel coronavirus has caused the outbreak of the acute respiratory disease in Wuhan, Hubei Province of China since December 2019. This study was performed to analyze the clinical characteristics of patients who succumbed to and who recovered from 2019 novel coronavirus disease (COVID-19).

Clinical data were collected from two tertiary hospitals in Wuhan. A retrospective investigation was conducted to analyze the clinical characteristics of fatal cases of COVID-19 (death group) and we compare them with recovered patients (recovered group). Continuous variables were analyzed using the Mann-Whitney U test. Categorical variables were analyzed by χ² test or Fisher exact test as appropriate.

Our study enrolled 109 COVID-19 patients who died during hospitalization and 116 recovered patients. The median age of the death group was older than the recovered group (69 [62, 74] vs. 40 [33, 57] years, Z = 9.738, P < 0.001). More patients in the death group had underlying diseases (72.5% vs. 41.4%, χ² = 22.105, P < 0.001). Patients in the death group had a significantly longer time of illness onset to hospitalization (10.0 [6.5, 12.0] vs. 7.0 [5.0, 10.0] days, Z = 3.216, P = 0.001). On admission, the proportions of patients with symptoms of dyspnea (70.6% vs. 19.0%, χ² = 60.905, P < 0.001) and expectoration (32.1% vs. 12.1%, χ² = 13.250, P < 0.001) were significantly higher in the death group. The blood oxygen saturation was significantly lower in the death group (85 [77, 91]% vs. 97 [95, 98]%, Z= 10.625, P < 0.001). The white blood cell (WBC) in death group was significantly higher on admission (7.23 [4.87, 11.17] vs. 4.52 [3.62, 5.88] × 10⁹/L, Z = 7.618, P < 0.001). Patients in the death group exhibited significantly lower lymphocyte count (0.63 [0.40, 0.79] vs. 1.00 [0.72, 1.27] ×10⁹/L, Z= 8.037, P < 0.001) and lymphocyte percentage (7.10 [4.45, 12.73]% vs. 23.50 [15.27, 31.25]%, Z = 10.315, P < 0.001) on admission, and the lymphocyte percentage continued to decrease during hospitalization (7.10 [4.45, 12.73]% vs. 2.91 [1.79, 6.13]%, Z= 5.242, P < 0.001). Alanine transaminase (22.00 [15.00, 34.00] vs. 18.70 [13.00, 30.38] U/L, Z = 2.592, P = 0.010), aspartate transaminase (34.00 [27.00, 47.00] vs. 22.00 [17.65, 31.75] U/L, Z = 7.308, P < 0.001), and creatinine levels (89.00 [72.00, 133.50] vs. 65.00 [54.60, 78.75] μmol/L, Z = 6.478, P < 0.001) were significantly higher in the death group than those in the recovered group. C-reactive protein (CRP) levels were also significantly higher in the death group on admission (109.25 [35.00, 170.28] vs. 3.22 [1.04, 21.80] mg/L, Z = 10.206, P < 0.001) and showed no significant improvement after treatment (109.25 [35.00, 170.28] vs. 81.60 [27.23, 179.08] mg/L, Z = 1.219, P = 0.233). The patients in the death group had more complications such as acute respiratory distress syndrome (ARDS) (89.9% vs. 8.6%, χ² = 148.105, P < 0.001), acute cardiac injury (59.6% vs. 0.9%, χ² = 93.222, P < 0.001), acute kidney injury (18.3% vs. 0%, χ² = 23.257, P < 0.001), shock (11.9% vs. 0%, χ² = 14.618, P < 0.001), and disseminated intravascular coagulation (DIC) (6.4% vs. 0%, χ² = 7.655, P = 0.006).

Compared to the recovered group, more patients in the death group exhibited characteristics of advanced age, pre-existing comorbidities, dyspnea, oxygen saturation decrease, increased WBC count, decreased lymphocytes, and elevated CRP levels. More patients in the death group had complications such as ARDS, acute cardiac injury, acute kidney injury, shock, and DIC.

We aimed to describe and analyze the pre-hospital emergency medical service (EMS) in Beijing and provide information for the government and medical institutions to optimize EMS.

We collected all pre-hospital emergency data in Beijing from 2008 to 2017. The chief complaint in each case was classified according to the Medical Priority Dispatch System (MPDS). The sites’ administrative districts were determined through geo-encoding of addresses and then classified into four functional regions. We analyzed the demand for EMS, emergency response times (ERT), and disease spectrum for Beijing as a whole, and for each functional region.

A total of 4,192,870 pre-hospital EMS cases met the inclusion criteria, with a significant increase (P < 0.001) of 51.60% from 2008 to 2017. EMS demand was positively associated with population (r= 0.946, P < 0.001). The pre-hospital EMS demand rate was 1907.05 in 2008 and 2172.23 in 2017 per 100,000, with no significant change (P = 0.57). ERT increased significantly (P = 0.001), from 19.18 min in 2008 to 24.51 min in 2016. According to MPDS classifications, the demand for pre-hospital care increased for 14 diseases, remained stable for 19, and decreased for only 1 disease. Cases of injury-related disease increased significantly from approximately 90,000 in 2017, accounting for 20% of all pre-hospital EMS cases, and the demand rate decreased in the core region but increased in the sub-urban regions. Cases of heart problems and stroke/transient ischemic attack also increased significantly in the four functional regions, with the highest demand rate in the Core Functional Region.

More resources and effort should be devoted to pre-hospital EMS according to the increased pre-hospital EMS demand and prolonged ERT in Beijing over our 10-year study period. Changes in disease spectrum and differences between functional regions should also be considered.

Imprecise interpretation of coronary angiograms was reported and resulted in inappropriate revascularization. Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) score is a comprehensive system to evaluate the complexity of the overall lesions. We hypothesized that a real-time SYNTAX score feedback from image analysts may rectify the mis-estimation and improve revascularization appropriateness in patients with stable coronary artery disease (CAD).

In this single-center, historical control study, patients with stable CAD with coronary lesion stenosis ≥50% were consecutively recruited. During the control period, SYNTAX scores were calculated by treating cardiologists. During the intervention period, SYNTAX scores were calculated by image analysts immediately after coronary angiography and were provided to cardiologists in real-time to aid decision-making. The primary outcome was revascularization deemed inappropriate by Chinese appropriate use criteria for coronary revascularization.

A total of 3245 patients were enrolled and assigned to the control group (08/2016-03/2017, n = 1525) or the intervention group (03/2017-09/2017, n= 1720). For SYNTAX score tertiles, 17.9% patients were overestimated and 4.3% were underestimated by cardiologists in the control group. After adjustment, inappropriate revascularization significantly decreased in the intervention group compared with the control group (adjusted odds ratio [OR]: 0.83; 95% confidence interval [CI]: 0.73-0.95; P = 0.007). Both inappropriate percutaneous coronary intervention (adjusted OR: 0.82; 95% CI: 0.74-0.92; P < 0.001) and percutaneous coronary intervention utilization (adjusted OR: 0.88; 95% CI: 0.79-0.98; P = 0.016) decreased significantly in the intervention group. There was no significant difference in 1-year adverse cardiac events between the control group and the intervention group.

Real-time SYNTAX score feedback significantly reduced inappropriate coronary revascularization in stable patients with CAD.

Nos. NCT03068858 and NCT02880605; https://www.clinicaltrials.gov.

Human epididymis secretory protein 4 (HE4) is a new ovarian cancer biomarker. The factors influencing HE4 levels are not clear, and the reference data in China are limited. Here, we aim to evaluate the effects of menopause and age on HE4 levels and to provide a possible reference value for HE4 in healthy Chinese people.

A total of 2493 healthy females aged 40 years or older were recruited from March 2013 to March 2017 with the cooperation of four medical institutions across Beijing, China. The serum levels of HE4 and cancer antigen 125 (CA125) were measured by enzyme-linked immunosorbent assay. The Wilcoxon rank-sum test of variance and a stratified analysis were used to analyze the relationships among age, menopausal status, and levels of HE4 or CA125. Confidence intervals (5%-95%) were determined for reference ranges in different populations.

There was a statistically significant difference in median HE4 levels between the post-menopausal (n = 2168) and premenopausal groups (n = 325) (36.46 vs. 24.04 pmol/L, Z = -14.41, P < 0.001). HE4 increased significantly with age in the post-menopausal groups (H= 408.18, P < 0.001) but not in the pre-menopausal subjects (Z=-0.43, P= 0.67). The upper 95th percentile of HE4 levels were 44.63 pmol/L for pre-menopausal women, 78.17 pmol/L for post-menopausal women, and 73.3 pmol/L for all women. In the post-menopausal population, the HE4 reference ranges were 13.15 to 47.31, 14.31 to 58.04, 17.06 to 73.51, 24.50 to 115.25, and 35.71 to 212.37 pmol/L for different age groups from forty divided by decade. The CA125 level was affected mainly by menopausal status and not age.

Menopausal status and age were both important factors influencing the level of HE4, and age affected HE4 levels mainly in post-menopausal women. The HE4 level was higher in the post-menopausal population than in the pre-menopausal population and increased with age.

Extra-corporeal video telescope operating monitor system provides a necessary instrument to perform high-precision neurosurgical procedures that could substitute or supplement the traditional surgical microscope. The present study was designed to evaluate a compact high-definition two-dimensional exoscope system for assisting in surgical removal of large vestibular schwannoma (VS), as an alternative to a binocular surgical microscope.

Patients with Koos grade 3 and grade 4 VS undergoing surgery were enrolled in this prospective cohort study between January 2013 and June 2018. The demographics and tumor characteristics (size, Koos grade, composition [cystic or solid mass]) were matched between the two groups of patients. The following outcome measurements were compared between the two groups: duration of surgery, volume of blood loss, extent of tumor resection, number of operating field adjustments, pre- and post-operative facial and cochlear nerve function evaluated at 3 months post-surgery, complications and surgeons’ comfortability.

A total of 81 patients received tumor resection through the retrosigmoid approach under either an exoscope (cases, n = 39) or a surgical microscope (control, n = 42). Patients in the two groups had comparable tumor location (P = 0.439), Koos grading (P = 0.867), and composition (P = 0.891). While no significant differences in the duration of surgery (P = 0.172), extent of tumor resection (P = 0.858), facial function (P = 0.838), and hearing ability (P = 1.000), patients operated on under an exoscope had less blood loss (P = 0.036) and a fewer field adjustments (P < 0.001). Both primary and assistant surgeons reported a high level of comfort operating under the exoscope (P = 0.001 and P < 0.001, respectively).

The compact high-definition two-dimensional exoscope system provides a safe and efficient means to assist in removing large VSs, as compared to a surgical microscope. After the acquaintance with a visual perception through a dynamic hint and stereoscopically viewing corresponding to the motion parallax, the exoscope system provided a comfortable, high-resolution visualization without compromising operational efficiency and patient safety.

The transforming growth factor β1 (TGF-β1)-induced epithelial-mesenchymal transition (EMT) has been proven associated with the pathogenesis of asthmatic airway remodeling, in which the Wnt/β-catenin pathway plays an important role, notably with regard to TGF-β1. Recent studies have shown that 1α, 25-dihydroxyvitamin D₃(1α, 25(OH)₂D₃) inhibits TGF-β1-induced EMT, although the underlying mechanism have not yet been fully elucidated.

Alveolar epithelial cells were exposed to 1α, 25(OH)₂D₃, ICG-001, or a combination of both, followed by stimulation with TGF-β1. The protein expression of E-cadherin, α-smooth muscle actin, fibronectin, and β-catenin was analyzed by western blotting and immunofluorescence analysis. The mRNA transcript of Snail was analyzed using RT-qPCR, and matrix metalloproteinase 9 (MMP-9) activity was analyzed by gelatin zymogram. The activity of the Wnt/β-catenin signaling pathway was analyzed using the Top/Fop flash reporters.

Both 1α, 25(OH)₂D₃ and ICG-001 blocked TGF-β1-induced EMT in alveolar epithelial cells. In addition, the Top/Fop Flash reporters showed that 1α, 25(OH)₂D₃ suppressed the activity of the Wnt/β-catenin pathway and reduced the expression of target genes, including MMP-9 and Snail, in synergy with ICG-001.

1α, 25(OH)₂D₃ synergizes with ICG-001 and inhibits TGF-β1-induced EMT in alveolar epithelial cells by negatively regulating the Wnt/β-catenin signaling pathway.

Epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs), such as erlotinib and gefitinib, are widely used to treat non-small cell lung cancer (NSCLC). However, acquired resistance is unavoidable, impairing the anti-tumor effects of EGFR-TKIs. It is reported that histone deacetylase (HDAC) inhibitors could enhance the anti-tumor effects of other antineoplastic agents and radiotherapy. However, whether the HDAC inhibitor suberoylanilide hydroxamic acid (SAHA) can overcome erlotinib-acquired resistance is not fully clear.

An erlotinib-resistant PC-9/ER cell line was established through cell maintenance in a series of erlotinib-containing cultures. NSCLC cells were co-cultured with SAHA, erlotinib, or their combination, and then the viability of cells was measured by the 3-(4,5-Dimethyl thiazol-2-yl)-2,5-diphenyl tetrazolium bromide assay and apoptosis was determined by flow cytometry and western blotting. Finally, the expression of phosphatase and tensin homolog deleted on chromosome 10 (PTEN) was assessed by western blotting.

The half-maximal inhibitory concentration of parental PC-9 cells was significantly lower than the established erlotinib-acquired resistant PC-9/ER cell line. PC-9/ER cells demonstrated reduced expression of PTEN compared with PC-9 and H1975 cells, and the combination of SAHA and erlotinib significantly inhibited cell growth and increased apoptosis in both PC-9/ER and H1975 cells. Furthermore, treating PC-9/ER cells with SAHA or SAHA combined with erlotinib significantly upregulated the expression of PTEN mRNA and protein compared with erlotinib treatment alone.

PTEN deletion is closely related to acquired resistance to EGFR-TKIs, and treatment with the combination of SAHA and erlotinib showed a greater inhibitory effect on NSCLC cells than single-drug therapy. SAHA enhances the suppressive effects of erlotinib in lung cancer cells, increasing cellular apoptosis and PTEN expression. SAHA can be a potential adjuvant to erlotinib treatment, and thus, can improve the efficacy of NSCLC therapy.

Rectal cancer (RC) is a malignant tumor that seriously threatens human health. Long non-coding RNAs (lncRNAs) play a vital role in tumor regulation. Nevertheless, their exact expression features and functions remain obscure, and therefore was the aim of the current study.

We utilized the Affymetrix human GeneChip to screen differentially expressed profiles of lncRNAs and mRNAs from the cancer tissues and matched paracancer tissues of 6 RC patients. Gene Ontology (GO) and pathway enrichment analyses identified crucial functions and pathways of the aberrantly expressed mRNAs. We used quantitative real-time polymerase chain reaction to verify the significant expression differences of 11 candidate lncRNAs between the cancer and paracancer tissues. LncRNA-mRNA coexpression networks were built by calculating the Pearson correlation value to identify significant correlation pairs. Online bioinformatics tools GEPIA2, ONCOMINE, and PROGgeneV2 were used to mine the expression and prognosis of three crucial mRNAs and six verified lncRNAs. Competing endogenous RNA networks were constructed by predicting microRNA response elements and calculating free energy.

We found 1658 differentially expressed lncRNAs (778 up-regulated and 880 down-regulated) and 1783 aberrantly expressed mRNAs (909 up-regulated and 874 down-regulated). GO and pathway enrichment analyses revealed the vital functions of the differentially expressed mRNAs, including cell proliferation, cell migration, angiogenesis, and cellular response to zinc ion. The canonical signaling pathways mainly included the interleukin-17, cell cycle, Wnt, and mineral absorption signaling pathways. Six lncRNAs including AC017002.2 (P= 0.039), cancer susceptibility 19 (CASC19) (P= 0.021), LINC00152 (P= 0.013), NONHSAT058834 (P= 0.007), NONHSAT007692 (P= 0.045), and ENST00000415991.1 (P= 0.045) showed significant differences in expression levels between the cancer tissue and paracancer tissue groups. AC017002.2, NONHSAT058834, NONHSAT007692, and ENST00000415991.1 have not yet been reported in RC. The crucial mRNAs myelocytomatosis viral oncogene (MYC), transforming growth factor beta induced (TGFBI), and solute carrier family 7 member 5 (SLC7A5) were selected. AC017002.2 and LINC00152 were positively correlated with MYC, TGFBI, and cytochrome P450 family 2 sub-family B member 6 (All r > 0.900, P < 0.050). NONHSAT058834 was positively associated with MYC (r = 0.930, P < 0.001), and CASC19 was positively correlated with SLC7A5 (r= 0.922, P < 0.001).

This study offers convincing evidence of differentially expressed lncRNAs and mRNAs as potential biomarkers in RC.

高流量鼻插管氧疗（HFNC）是一种新型的呼吸支持技术，近年来在临床上得到了广泛应用。这种治疗设备主要包括空气-氧气混合器、主动加湿器、高流量鼻插管和连接吸气回路。它为患者提供氧气浓度（21-100%）、温度（31-37℃）相对稳定的加湿高流量气体（8-80 L/min）并通过鼻插管进行氧疗，非常舒适。^[1]通过吸入高流量气体，HFNC可以产生一定水平的呼气末正压^[2]并清洗上呼吸道的生物死腔。^[3]通过高流量鼻插管提供的恒温恒湿气体可以维持粘膜纤毛清除系统的功能^[4]减少患者上气道阻力和呼吸努力，改善气体交换和部分通气功能。

Helicobacter pylori (HP) has been considered to be one of the primary causes of gastric mucosa-associated lymphoid tissue (MALT) lymphoma since 1993. Low-grade gastric MALT lymphoma with HP is widely treated with HP eradication therapy, according to each specific clinical situation. However, several studies and guidelines indicate that the modified HP eradication therapy is also valid for HP-negative gastric MALT lymphoma. The aim of this study was to perform a meta-analysis of the clinical efficacy of the modified HP eradication therapy for gastric MALT lymphoma without HP.

We searched studies that reported the response rate of the modified HP eradication therapy regimen for gastric MALT lymphoma without HP by using PubMed, Medline, and Ebsco from January 1971 until February 2019. All statistical analyses were carried out using R 3.5.3 (Mathsoft Company, Cambridge, MA, USA). The pooled response rate was expressed as a decimal. The heterogeneity test was performed using the I-squared (I²) statistic.

A total of 14 studies were selected with a total of 148 patients with HP-negative gastric MALT lymphoma. The overall pooled response rate was 0.38 (95% confidence interval [CI]: 0.29-0.47). The combined estimate is I² = 57% (P < 0.01). The study subjects were categorized by factors (area of patients). The pooled response rate of the sub-groups (Korea, Japan, China, and Western countries) was 0.63 (95% CI: 0.50-0.76), 0.16 (95% CI: 0.05-0.30), 0.38 (95% CI: 0.20-0.55), and 0.57 (95% CI: 0.08-1.00). The response rate showed that the modified HP eradication therapy was effective for patients with HP-negative gastric MALT lymphoma, especially in Korea and Western countries.

Therefore, the modified HP eradication therapy can be considered an optional therapy for patients with low-grade HP-negative gastric MALT lymphoma. However, several limitations were revealed in the meta-analysis. Further systematic reviews and research are required.

自2019冠状病毒病（COVID-19）爆发以来，中华人民共和国国家卫生健康委员会发布了一系列及时更新的指南。《新型冠状病毒肺炎病诊疗方案（试行第七版）》于2020年3月3日公布，是在积累的临床经验和对疾病更深入的认识基础上发展而来的。^[1]与第六版相比，最新版对传播途径、病理特征、临床特征、诊断、分诊、治疗、出院标准等内容进行了修订。为了更好地理解协议，本文对第七版进行了简要解释。

2019年12月，武汉市首次报告了新型冠状病毒（2019新型冠状病毒）感染病例，称为2019冠状病毒病（COVID-19）。^[1]在人类中，人冠状病毒229E、OC43、NL63和HKU1的感染通常导致轻度、自限性上呼吸道感染。然而，其他变种传播速度快，可导致严重呼吸综合征和死亡。这些变种包括严重急性呼吸综合征冠状病毒（SARS-CoV）、中东呼吸综合征冠状病毒（MERS-CoV）和当前的2019新型冠状病毒。

高血压作为最常见的心血管疾病（CVD），发病率很高。2015年，该疾病在全球影响了约11.3亿人口，在18岁以上的中国人中，其患病率超过27.9%。^[1]不幸的是，生活方式的改变和医疗干预未能控制三分之一患者的疾病。人类肠道微生物群可以调节免疫、炎症和新陈代谢。几十年来，越来越多的证据表明，微生物群的活性和组成与健康状况有关（就像影响血脂和血糖一样），这为高血压的发生机制提供了新的见解。^[2,3]

近几十年来，双胎妊娠显著增加，主要是由于通过辅助生殖技术实现的此类妊娠的增长率。双胎妊娠与高婴儿发病率和死亡率相关。已经发现母体肥胖与先兆子痫和其他不良结局的风险增加显著相关。怀孕期间母亲体重增加可能对母亲和胎儿健康有重要影响。妊娠期体重增加过多（GWG）的妇女更有可能增加妊娠期糖尿病（GDM）、巨大儿、早产和胎儿生长受限的风险。与单胎一样，预计GDM在双胞胎的孕前肥胖母亲中也更常见。^[1]虽然有一些双胎妊娠指南，但很少有研究关注双胎妊娠的系统管理。本研究的主要目的是评估系统管理双胎妊娠的益处，特别是GDM样饮食和运动管理模式。

线粒体三功能蛋白（MTP）是一种多酶复合物，催化长链脂肪酸的线粒体β-氧化的最后三个步骤。在结构上，MTP由四个α亚基和四个β亚基组成，它们由哈达基因（OMIM 600890）和哈德卜基因（OMIM 143450）。突变哈达或者哈德卜导致MTP活性不同程度的下降，进而导致三种类型的临床表现：新生儿发病的严重表型、婴儿发病的肝脏表型和晚发病的神经肌病表型。^[1]神经肌病型最轻，以肌病、感觉运动神经病变、复发性横纹肌溶解为特征。^[1,2]据我们所知，迄今为止全世界仅报告了33例，^[1,2]其中中国仅有2例病例（包括本研究的患者3）。^[3]在这里，我们描述了三例早发的中国病例，它们不仅表现为神经肌病和横纹肌溶解症，还累及中枢神经系统（CNS），这在这种表型中并不常见。

尽管在概念和手术技术方面取得了巨大进步，但对于大多数心脏手术中心来说，牙弓置换仍然是一个挑战。经典的Sun手术（使用带支架象鼻植入的四分支移植物进行全弓置换）在A型主动脉夹层病例的弓置换中取得了良好的效果，成为我中心A型主动脉夹层的标准治疗方法。^[1,2]一些外科医生已经报道了分支优先技术。大多数病例在体外循环（CPB）或深低温停循环下重建三支弓。一年前，我们开始应用分支优先的Sun程序。^[3]大多数患者在没有CPB的情况下绕过了三个弓分支。循环停止时的最低温度也升高。在这里，我们报告了我们在选择性和紧急情况下使用分支优先Sun手术的早期经验。

妊娠期糖尿病（GDM）表现为妊娠期不同程度的碳水化合物不耐受。根据几项研究，GDM影响4%至25%的孕妇。大多数GDM患者存在不同程度的胰岛素抵抗和慢性低度炎症，这与血管损伤和功能障碍以及随后的血小板活化有关。^[1]因此，血小板活化可能与GDM严重程度密切相关。平均血小板体积（MPV）是用于评价血小板形态和活性的指标之一。MPV升高已被证明与心血管疾病和其他病症有关，如高血压和非酒精性脂肪性肝病。^[2]据我们所知，很少有研究证明MPV和GDM之间的关系。我们的目的是评估MPV对妊娠早期GDM的诊断价值。

过敏原免疫疗法通过向患有过敏性疾病的患者重复施用特定的过敏原以防止过敏反应来执行。它是过敏性鼻炎和哮喘的唯一疾病缓解疗法，许多临床试验和荟萃分析都证明了其有益作用。^[1]与免疫治疗相关的免疫学变化是复杂的，其潜在机制需要进一步阐明。集群免疫疗法是一种改进的免疫疗法，具有加速的累积时间表，比传统方法更早实现症状改善。^[1]本研究旨在通过采用转录组谱分析和鉴定免疫治疗早期评估的候选生物标志物来研究集群免疫治疗引起的早期免疫变化。已获得北京协和医院伦理委员会批准（编号：ZS-1917），所有受试者均已书面知情同意书。

致编辑：在一项前瞻性、自我对照、评估者盲法、观察性研究中，Wang等人^[1]评估超声测量指标与困难喉镜检查的相关性。通过多变量逻辑回归分析和接受者特征（ROC）曲线分析，他们得出结论，超声下会厌和声门之间的角度大小与喉镜检查困难高度相关。此外，当该角度小于50°时，可能会发生困难的喉镜检查。鉴于困难气道仍然是接受全身麻醉的手术患者不良结局的主要原因之一，并且没有具有高灵敏度的临床指标可以可靠地预测困难气道，^[2]他们的发现具有潜在的临床意义。然而，我们注意到他们研究中的一些方法问题，这些问题会使他们的发现受到质疑。

致编辑：肌萎缩侧索硬化（ALS）是一种与上下运动神经元变性相关的无情进行性神经肌肉疾病。它最终导致肌肉无力、萎缩，并在3至5年内死亡，最常见的是呼吸衰竭。这些患者，尤其是产妇的适当麻醉管理给麻醉师带来了各种挑战。

致编辑：最近的研究表明，骨的形态在体内，包括骨骼的形状、直径、长度、曲线和排列，适应骨骼成熟前后的长期负荷。根据应变的大小、作用方式、位置和应变的骨质量不同，变形和速率也不同，这被称为骨动态变形定律。^[1]在这里，我们通过P45塑化技术发现跟骨中圆形骨小梁的存在。根据这一规律，它可能是由于小腿三头肌收缩时力传导到趾短屈肌所致。

致编辑：多粘菌素抗生素粘菌素（多粘菌素E）和多粘菌素B（PMB）于20世纪50年代问世；因此，他们没有经历当代药物开发程序。它们的临床应用最近重新兴起，作为无法治疗的革兰氏阴性感染的挽救疗法发挥了重要作用。^[1]多重耐药(MDR)细菌感染主要由革兰氏阴性杆菌(GNB)引起，例如铜绿假单胞菌和肺炎克雷伯菌，在肺移植(LT)患者中。^[2]LT患者中MDR-GNB感染患病率的增加导致了这些“老”药物的使用激增。在治疗过程中应注意PMB伴发的神经肌肉阻滞引起的严重危及生命的呼吸麻痹。在此，我们报告了一例罕见的67岁LT患者，他患有PMB诱导的呼吸骤停。

致编辑：瘢痕疙瘩是一种特殊类型的疤痕，超过原始伤口边界，不太可能自发收缩。已经报道了许多治疗瘢痕疙瘩的方法，包括手术切除、放射、注射、激光疗法和冷冻疗法。然而，没有一种方法可以确保完全治愈。在已报道的方法中，病灶内注射类固醇被广泛使用。大量研究表明，在瘢痕疙瘩内注射糖皮质激素联合5-氟尿嘧啶（5-FU），可软化瘢痕疙瘩质地，缩小体积，缓解相关症状。^[1]常规的病灶内注射通常是通过以多点方式通过瘢痕疙瘩表面直接注射到实质中来进行的。然而，这种方法引起的显著疼痛通常会影响患者的依从性。此外，很难将药物均匀地分布到牢固和紧密的纤维结构中，这可能降低治疗效果。因此，我们将该技术改进为两步操作，首先注射到瘢痕疙瘩的基部，然后注射到实质。

致编辑：在晚期头颈部恶性肿瘤中，特别是经颈部手术或放疗史等综合治疗后复发的患者，肿瘤可同时侵犯粘膜和皮肤。肿瘤切除后形成的穿透性缺损的重建必须达到以下目的：（1）重建消化道，恢复吞咽功能。（2）为颈部重要结构的修复提供软组织，即重建颈部的皮肤。我们采用双侧锁骨上动脉岛状皮瓣修复1例喉恶性肿瘤晚期患者术后颈部大面积皮肤伴粘膜缺损，术后效果满意。

致编辑：梅毒是一种由梅毒螺旋体（T.pallidum）继发性梅毒病变通常发生在初次暴露于T.苍白球二期梅毒最常见的皮肤表现是黄斑和丘疹。然而，其他不常见的病变，如结节性、脓疱性、弓形和银屑病样病变，偶尔也有报道。^[1,2]环状梅毒病变相对罕见，通常表现为多发性病变散在全身或局限于生殖器等局部皮肤。^[1,3]在此，我们报告了一例面部二期梅毒的孤立环形病变。

致编辑：从临床样本中识别病原体对于新出现的传染病的诊断至关重要，例如对全球公共卫生构成巨大威胁的2019年新型冠状病毒（2019新型冠状病毒）。^[1]在某些情况下，尽管有阳性的流行病学、临床和放射学证据，冠状病毒疾病2019（新冠肺炎）诊断仍可能受到不确定的聚合酶链反应（PCR）结果的限制。^[2]对于可疑患者的样本，其中少数呼吸道标本的荧光定量PCR（FQ-PCR）结果不确定，高通量测序（HTS）可以是一种有效的确认方法。在这里，我们报告了应用HTS确认疑似2019新型冠状病毒感染的经验。