Volume 134 · Issue 10 · 2021

在过去10年中，靶向程序性死亡-1（PD-1）/程序性死亡配体1（PD-L1）轴的免疫检查点抑制剂（ICIs）改变了非小细胞肺癌（NSCLC）的治疗前景，并在一部分患者中产生了长期生存益处。在这篇社论中，我们重点关注了ICIs在非小细胞肺癌患者中的最新进展和挑战。

Single-nucleotide polymorphisms (SNPs)-associated genes and long non-coding RNAs (lncRNAs) can contribute to human disease. To comprehensively investigate the contribution of lncRNAs to breast cancer, we performed the first genome-wide lncRNA association study on Han Chinese women.

We designed an lncRNA array containing >800,000 SNPs, which was incorporated into a 96-array plate by Affymetrix (CapitalBio Technology, China). Subsequently, we performed a two-stage genome-wide lncRNA association study on Han Chinese women covering 11,942 individuals (5634 breast cancer patients and 6308 healthy controls). Additionally, in vitro gain or loss of function strategies were performed to clarify the function of a novel SNP-associated gene.

We identified a novel breast cancer-associated susceptibility SNP, rs11066150 (P_meta = 2.34 × 10^-8), and a previously reported SNP, rs9397435 (P_meta= 4.32 × 10^-38), in Han Chinese women. rs11066150 is located in NONHSAT164009.1 (lncHSAT164), which is highly expressed in breast cancer tissues and cell lines. lncHSAT164 overexpression promoted colony formation, whereas lncHSAT164 knockdown promoted cell apoptosis and reduced colony formation by regulating the cell cycle.

Based on our lncRNA array, we identified a novel breast cancer-associated lncRNA and found that lncHSAT164 may contribute to breast cancer by regulating the cell cycle. These findings suggest a potential therapeutic target in breast cancer.

Diabetes mellitus (DM) is an important risk factor in the long-term outcomes of surgical revascularization. However, few studies have focused on patients with ischemic heart failure (IHF) and DM, and the results are controversial. This study aimed to evaluate the effect of DM on the long-term outcomes of IHF patients undergoing coronary artery bypass grafting (CABG).

In this propensity-matched study, data of IHF patients who underwent CABG in our hospital from January 2007 to December 2017 were analyzed. With a mean 73-month follow-up time, the patients were divided into two groups according to whether they had DM. The primary endpoint was all-cause death, and the secondary endpoint was a composite of all-cause death, stroke, recurrent myocardial infarction, and revascularization.

There was no significant difference in all-cause mortality between the two groups (5.8% vs. 4.1%, P = 0.216). The incidence of main adverse cardiovascular and cerebrovascular events (MACCE) in the secondary endpoint was significantly higher in the DM group than that in the non-DM group (10.4% vs. 8.1%, P = 0.023).

DM can negatively affect the long-term outcomes of IHF patients undergoing CABG by significantly increasing the overall incidence of MACCE, though the long-term survival does not show a significant difference between the DM and non-DM patients.

Compared to adult studies, studies which involve the treatment of pediatric congenital hypogonadotropic hypogonadism (CHH) are limited and no universal treatment regimen is available. The aim of this study was to evaluate the feasibility of human chorionic gonadotropin (hCG)/human menopausal gonadotropin (hMG) therapy for treating male adolescents with CHH.

Male adolescent CHH patients were treated with hCG/hMG (n = 20) or a gonadotropin-releasing hormone (GnRH) pump (n = 21). The treatment was divided into a study phase (0-3 months) and a follow-up phase (3-12 months). The testicular volume (TV), penile length (PL), penis diameter (PD), and sex hormone levels were compared between the two groups. The TV and other indicators between the groups were analyzed using a t-test (equal variance) or a rank sum test (unequal variance).

Before treatment, there was no statistical difference between the two groups in terms of the biochemistry, hormones, and other demographic indicators. After 3 months of treatment, the TV of the hCG/hMG and GnRH groups increased to 5.1 ± 2.3 mL and 4.1 ± 1.8 mL, respectively; however, the difference was not statistically significant (P > 0.05, t= 1.394). The PL reached 6.9 ± 1.8 cm and 5.1 ± 1 .6 cm (P < 0.05, t= 3.083), the PD reached 2.4 ± 0.5 cm and 2.0 ± 0.6 cm (P < 0.05, t= 2.224), respectively, in the two groups. At the end of 6 months of treatment, biomarkers were in normal range in the two groups. Compared with the GnRH group, the testosterone (T) level and growth of PL and PD were significantly greater in the hCG/hMG group (all P < 0.05). While the TV of both groups increased, the difference was not statistically significant (P > 0.05, t = 0.314). After 9 to 12 months of treatment, the T level was higher in the hCG/hMG group. Other parameters did not exhibit a statistical difference.

The hCG/hMG regimen is feasible and effective for treating male adolescents with CHH. The initial 3 months of treatment may be a window to optimally observe the strongest effects of therapy. Furthermore, results from the extended time-period showed positive outcomes at the 1-year mark; however, the long-term effectiveness, strengths, and weaknesses of the hCG/hMG regimen require further research.

ClinicalTrials.gov, NCT02880280; https://clinicaltrials.gov/ct2/show/NCT02880280.

Hepatitis B core-related antigen (HBcrAg) is a promising disease-monitoring marker for chronic hepatitis B (CHB). We investigated correlations between HBcrAg with antiviral efficacy and virological and histological variables.

One hundred and forty-five CHB patients from the mainland of China between August 2013 and September 2016 who underwent liver biopsy received entecavir therapy and had paired liver biopsy at 78 weeks. We analyzed correlations between HBcrAg and virological and histological variables in hepatitis B e antigen (HBeAg)-positive and HBeAg-negative patients. We also explored the predictors of HBeAg loss after 78 weeks of antiviral therapy. Pearson correlation analysis and logistic forward stepwise regression were the main statistic methods.

HBeAg-positive patients (n = 93) had higher baseline HBcrAg (median 7.4 vs. 5.3 log₁₀ U/mL P < 0.001) and greater HBcrAg declines (median 1.6 vs. 0.9 log₁₀ U/mL P= 0.007) than HBeAg-negative patients after 78 weeks of therapy. At baseline, HBcrAg correlated with hepatitis B virus (HBV) DNA in both HBeAg-positive (r = 0.641, P < 0.001) and -negative patients (r = 0.616, P < 0.001), with hepatitis B surface antigen (HBsAg) in HBeAg-positive patients (r = 0.495, P < 0.001), but not with anti-hepatitis B virus core antibody (anti-HBc). Weak correlations existed between HBcrAg, histology activity index (HAI; r = 0.232, P= 0.025), and Ishak fibrosis score (r= -0.292, P= 0.005) in HBeAg-positive patients. At 78 weeks, significant correlations existed only between HBcrAg and anti-HBc in HBeAg-positive (r = -0.263, P = 0.014) and HBeAg-negative patients (r= -0.291, P= 0.045). Decreased HBcrAg significantly correlated with reduced HBV DNA (r= 0.366, P= 0.001; r= 0.626, P < 0.001) and HBsAg (r = 0.526, P = 0.001; r = 0.289, P = 0.044) in HBeAg-positive and -negative patients, respectively, and with reduced HAI in HBeAg-positive patients (r = 0.329, P = 0.001). Patients with HBeAg loss (n = 29) showed a larger reduction in HBcrAg than those without (median 2.3 vs. 1.3 log₁₀ U/mL, P = 0.001). In multivariate analysis, decreased HBcrAg was an independent predictor of HBeAg loss (P = 0.005).

HBcrAg reflects viral replication and protein production. Decreased HBcrAg could predict HBeAg loss after antiviral therapy.

Clinical Trials.gov: NCT01962155; https://www.clinicaltrials.gov/ct2/show/NCT01962155?term=NCT01962155&draw=2&rank=1

Follistatin-like 1 (FSTL1) plays both pro-inflammatory and anti-inflammatory roles in the inflammatory processes. We investigated whether serum FSTL1 could predict the current anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV)-specific indices.

We randomly selected 74 patients with AAV from a prospective and observational cohort of Korean patients with AAV. Clinical and laboratory data and AAV-specific indices were recorded. FSTL1 concentration was determined using the stored sera. The lowest tertile of the short-form 36-item health survey (SF-36) was defined as the current low SF-36. The cutoffs of serum FSTL1 for the current low SF-36 physical component summary (PCS) and SF-36 mental component summary (MCS) were extrapolated by the receiver operator characteristic curve.

The median age was 62.5 years (55.4% were women). Serum FSTL1 was significantly correlated with SF-36 PCS (r = -0.374), SF-36 MCS (r = -0.377), and C-reactive protein (CRP) (r = 0.307), but not with Birmingham vasculitis activity score (BVAS). In the multivariable linear regression analyses, BVAS, CRP, and serum FSTL1 were independently associated with the current SF-36 PCS (β = -0.255, β = -0.430, and β = -0.266, respectively) and the current SF-36 MCS (β = -0.234, β=-0.229, and β= -0.296, respectively). Patients with serum FSTL1 ≥779.8 pg/mL and those with serum FSTL1 ≥841.6 pg/mL exhibited a significantly higher risk of having the current low SF-36 PCS and SF-36 MCS than those without (relative risk 7.583 and 6.200, respectively).

Serum FSTL1 could predict the current functional status in AAV patients.

Despite almost two decades of well-funded and comprehensive response efforts by the Chinese Government, human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) remains a major problem in China. Yet, few studies have recently examined long-term trends in HIV/AIDS prevalence, incidence, and mortality at the national level. This study aimed to determine the prevalence, incidence, and mortality trends for HIV/AIDS over the past 28 years in China.

We conducted a descriptive, epidemiological, secondary analysis of the Global Burden of Diseases, Injuries, and Risk Factors Study 2017 data. To evaluate trends in prevalence, incidence, and mortality over the study period from 1990 to 2017, we calculated values for annual percentage change (APC) and corresponding 95% confidence intervals (CIs) using joinpoint regression analysis.

A significant increase in HIV/AIDS prevalence was observed for 1990 to 2009 (APC: 10.7; 95% CI: 10.4, 11.0; P < 0.001), and then remained stable for 2009 to 2017 (APC: 0.7; 95% CI: -0.3, 1.7; P = 0.1). A significant increase in HIV incidence was also observed for 1990 to 2005 (APC: 13.0; 95% CI: 12.6, 13.4; P < 0.001), and then a significant decrease was detected for 2005 to 2017 (APC: -6.5; 95% CI: -7.0, -6.1; P < 0.001). A significant increase in AIDS-related mortality rate was detected for 1990 to 2004 (APC: 10.3; 95% CI: 9.3, 11.3; P < 0.001), followed by a period of stability for 2004 to 2013 (APC: 1.3; 95% CI: -0.7, 3.3; P = 0.2), and then another significant increase for 2013 to 2017 (APC: 15.3; 95% CI: 8.7, 22.2; P < 0.001).

Although prevalence has stabilized and incidence has declined, AIDS-related mortality has risen sharply in recent years. These findings suggest more must be done to bring people into treatment earlier, retain them in treatment more effectively, actively seek to reenter them in treatment if they dropout, and improve the quality of treatment and care regimens.

Pre-operative non-invasive histological evaluation of hepatocellular carcinoma (HCC) remains a challenge. Tumor perfusion is significantly associated with the development and aggressiveness of HCC. The purpose of the study was to evaluate the clinical value of quantitative liver perfusion parameters and corresponding histogram parameters derived from traditional triphasic enhanced computed tomography (CT) scans in predicting histological grade of HCC.

Totally, 52 patients with HCC were enrolled in this retrospective study and underwent triple-phase enhanced CT imaging. The blood perfusion parameters were derived from triple-phase CT scans. The relationship of liver perfusion parameters and corresponding histogram parameters with the histological grade of HCC was analyzed. Receiver operating characteristic (ROC) curve analysis was used to determine the optimal ability of the parameters to predict the tumor histological grade.

The variance of arterial enhancement fraction (AEF) was significantly higher in HCCs without poorly differentiated components (NP-HCCs) than in HCCs with poorly differentiated components (P-HCCs). The difference in hepatic blood flow (HF) between total tumor and total liver flow (ΔHF = HF_tumor -HF_liver) and relative flow (rHF = ΔHF/HF_liver) were significantly higher in NP-HCCs than in P-HCCs. The difference in portal vein blood supply perfusion (PVP) between tumor and liver tissue (ΔPVP) and the ΔPVP/liver PVP ratio (rPVP) were significantly higher in patients with NP-HCCs than in patients with P-HCCs. The area under ROC (AUC) of ΔPVP and rPVP were both 0.697 with a high sensitivity of 84.2% and specificity of only 56.2%. The ΔHF and rHF had a higher specificity of 87.5% with an AUC of 0.681 and 0.673, respectively. The combination of rHF and rPVP showed the highest AUC of 0.732 with a sensitivity of 57.9% and specificity of 93.8%. The combined parameter of ΔHF and rPVP, rHF and rPVP had the highest positive predictive value of 0.903, and that of rPVP and ΔPVP had the highest negative predictive value of 0.781.

Liver perfusion parameters and corresponding histogram parameters (including ΔHF, rHF, ΔPVP, rPVP, and AEF_variance) in patients with HCC derived from traditional triphasic CT scans may be helpful to non-invasively and pre-operatively predict the degree of the differentiation of HCC.

The prevalence of skin diseases and diabetes mellitus (DM) are prominent around the world. The current scope of knowledge regarding the prevalence of skin diseases and comorbidities with type 2 DM (T2DM) is limited, leading to limited recognition of the correlations between skin diseases and T2DM.

We collected 383 subjects from the Da Qing Diabetes Study during the period from July 9th to September 1st, 2016. The subjects were categorized into three groups: Normal glucose tolerance (NGT), impaired glucose tolerance (IGT), and T2DM. The prevalence and clinical characteristics of skin diseases were recorded and investigated.

In this cross-sectional study, 383 individuals with ages ranging from 53 to 89-year-old were recruited. The overall prevalence of skin diseases was 93.5%, and 75.7% of individuals had two or more kinds of skin diseases. Additionally, there were 47 kinds of comorbid skin diseases in patients with T2DM, of which eight kinds of skin diseases had a prevalence >10%. The prevalence of skin diseases in NGT, IGT, and T2DM groups were 93.3%, 91.5%, and 96.6%, respectively; stratified analysis by categories showed a statistically significant difference in "disturbances of pigmentation" and "neurological and psychogenic dermatoses" . The duration of T2DM also significantly associated with the prevalence of "disturbances of pigmentation" and "neurological and psychogenic dermatoses" . Subsequently, the prevalence of "disturbances of pigmentation" was higher in males than females in NGT (P < 0.01) and T2DM (P < 0.01) groups. In addition, the difference in the prevalence of "disturbances of pigmentation" was also significant in NGT and T2DM groups (P < 0.01).

There was a high prevalence of skin diseases in the Da Qing Diabetes Study. To address the skin diseases in the Da Qing Diabetes Study, increased awareness and intervention measures should be implemented.

For patients with B cell acute lymphocytic leukemia (B-ALL) who underwent allogeneic stem cell transplantation (allo-SCT), many variables have been demonstrated to be associated with leukemia relapse. In this study, we attempted to establish a risk score system to predict transplant outcomes more precisely in patients with B-ALL after allo-SCT.

A total of 477 patients with B-ALL who underwent allo-SCT at Peking University People’s Hospital from December 2010 to December 2015 were enrolled in this retrospective study. We aimed to evaluate the factors associated with transplant outcomes after allo-SCT, and establish a risk score to identify patients with different probabilities of relapse. The univariate and multivariate analyses were performed with the Cox proportional hazards model with time-dependent variables.

All patients achieved neutrophil engraftment, and 95.4% of patients achieved platelet engraftment. The 5-year cumulative incidence of relapse (CIR), overall survival (OS), leukemia-free survival (LFS), and non-relapse mortality were 20.7%, 70.4%, 65.6%, and 13.9%, respectively. Multivariate analysis showed that patients with positive post-transplantation minimal residual disease (MRD), transplanted beyond the first complete remission (≥CR2), and without chronic graft-versus-host disease (cGVHD) had higher CIR (P < 0.001, P= 0.004, and P < 0.001, respectively) and worse LFS (P < 0.001, P= 0.017, and P < 0.001, respectively), and OS (P < 0.001, P = 0.009, and P < 0.001, respectively) than patients without MRD after transplantation, transplanted in CR1, and with cGVHD. A risk score for predicting relapse was formulated with the three above variables. The 5-year relapse rates were 6.3%, 16.6%, 55.9%, and 81.8% for patients with scores of 0, 1, 2, and 3 (P < 0.001), respectively, while the 5-year LFS and OS values decreased with increasing risk score.

This new risk score system might stratify patients with different risks of relapse, which could guide treatment.

The optimal treatment for large impacted proximal ureteral stones remains controversial. The aim of this study was to evaluate the efficacy, safety, and potential complications of mini-percutaneous nephrolithotomy (MPCNL) and retroperitoneal laparoscopic ureterolithotomy (RPLU) in the treatment of impacted proximal ureteral stones with size greater than 15 mm.

A total of 268 patients with impacted proximal ureteral stones greater than 15 mm who received MPCNL or RPLU procedures were enrolled consecutively between January 2014 and January 2019. Data on surgical outcomes and complications were collected and analyzed.

Demographic and ureteral stone characteristics found between these two groups were not significantly different. The surgical success rate (139/142, 97.9% vs. 121/126, 96.0%, P = 0.595) and stone-free rate after 1 month (139/142, 97.9% vs. 119/126, 94.4%, P = 0.245) of RPLU group were marginally higher than that of the MPCNL group, but there was no significant difference. There was no significant difference in the drop of hemoglobin between the two groups (0.8 ± 0.6 vs. 0.4 ± 0. 2 g/dL, P = 0.621). The mean operative time (68.2 ± 12.5 vs. 87.2 ± 16.8 min, P = 0.041), post-operative analgesics usage (2/121, 1.7% vs. 13/139, 9.4%, P = 0.017), length of hospital stay after surgery (2.2 ± 0.6 vs. 4.8 ± 0.9 days, P < 0.001), double J stent time (3.2 ± 0.5 vs. 3.9 ± 0.8 days, P = 0.027), time of catheterization (1.1 ± 0.3 vs. 3.5 ± 0.5 days, P < 0.001), and time of drainage tube (2.3 ± 0.3 vs. 4.6 ± 0.6 days, P < 0.001) of MPCNL group were significantly shorter than that of the RPLU group. The complication rate was similar between the two groups (20/121, 16.5% vs. 31/139, 22.3%, P = 0.242).

MPCNL and RPLU have similar surgical success and stone clearance in treating impacted proximal ureteral stones greater than 15 mm, while patients undergoing MPCNL had a lower post-operative pain rate and a faster recovery.

慢性完全闭塞（CTO）是冠状动脉完全闭塞>3个月，合并心肌梗死（TIMI）流量0级溶栓。经皮冠状动脉介入治疗（PCI）广泛用于治疗CTO，但使用少于冠状动脉旁路移植术（CABG）。^[1]然而，与非CTO PCI相比，CTO PCI可能会增加患者和手术医生的辐射暴露，^[2]更高的辐射暴露与长期的不良后果有关。^[3]PCI操作者在每次手术中暴露于明显少于患者的辐射；然而，一生中反复接触可能会导致健康问题。因此，在不影响手术成功率和患者临床结局的情况下，减少PCI心脏病专家的辐射暴露至关重要。低帧速率(LFR)协议和/或选择性荧光透视图像存储减少了PCI操作者和患者在PCI期间对辐射的暴露。本研究的目的是评估LFR方案管理CTO患者的安全性和有效性。

冠状病毒疾病2019（新冠肺炎）源于感染新型严重急性呼吸综合征冠状病毒2（新型冠状病毒）。^[1]易感人群可以是任何年龄和性别；因此，这种疾病威胁着每个人的健康和生命，包括孕妇。妊娠可影响各种器官的生理功能，从而可能影响许多感染性疾病的预后。例如，与非妊娠患者相比，感染SARS-CoV的妊娠患者的死亡率和并发症更多。^[2]

神经节阻滞最早由Plancarte于1990年提出等人.^[1]此后，Wemm和Saberski报道了几个修改版本，^[2]尼巴布和佛罗伦萨，^[3]还有弗耶。^[4]他们试图通过考虑神经节和尾骨的解剖结构来有效地减轻疼痛。每个人的技术强度都有差异。然而，由于结构本身的解剖学多样性，^[5]很难确定哪种技术更有效。在神经节阻滞中发展起来的射频消融（RFA）也面临着这一争议。在这种临床背景下，我们提出了一种新的技术来实施神经节impar RFA。在研究开始前获得患者的书面知情同意书。

近几十年来，在发达国家和发展中国家，过敏性疾病的发病率都在迅速增加。^[1]在中国，花粉艾蒿是第一次全国各省花粉调查报告的最重要的室外过敏原之一。^[2]艾蒿花粉被发现是季节性哮喘的重要原因。^[3]艾蒿和黄花蒿是最重要的艾蒿中国的物种。普通曲霉主要生长在西部地区，而A.黄花盛产于人口稠密的北部和东部地区。^[4]免疫球蛋白E（IgE）抗体在过敏性疾病中起着关键作用。它们由B细胞合成和释放，并与肥大细胞或嗜碱性粒细胞上的高亲和力IgE受体结合。^[5]一旦患者暴露于相应的过敏原，效应细胞将被触发，然后释放其介质，导致过敏性炎症。^[5]基于患者特异性过敏原的过敏原免疫疗法被认为是一种有前途且有效的过敏性疾病治疗方法。^[6,7]因此，鉴定IgE结合过敏原将提高过敏性疾病的诊断和免疫治疗的应用。然而，以前的研究主要研究来自普通曲霉（第五条），如第五条1-6。至于A.黄花（Art an），只有两种过敏原被鉴定为Art an 1（防御素样蛋白）和Art an 7（推定的半乳糖氧化酶）。^[4]因此，研究过敏原是很重要的A.黄花花粉。

致编辑：大多数多原发恶性肿瘤是异时性的或涉及一个以上系统，相反，我们描述了一个涉及一个器官系统的同步三重癌症的病例。

致编辑：肝脏是转移性肿瘤最脆弱的器官之一。肝转移性肿瘤比原发性肝肿瘤(LM)常见约18至40倍。中国每年新发卵巢癌患者约5万人，年死亡率约40%。^[1]目前，恶性肿瘤LM的治疗方法包括手术治疗和非手术治疗。非手术治疗主要包括全身化疗、射频消融（RFA）、经动脉化疗栓塞（TACE）等。

致编辑：寻常痤疮是一种常见的慢性炎症性皮肤病。它是世界上第八大流行疾病。在青少年中，超过85%的人曾经患有痤疮。^[1]而且，根据最近的证据，^[2]由于其复发和愈合后留下的疤痕或炎症后色素沉着，患者经常经历巨大的身体和精神压力，尤其是在大学生中。在中国，虽然有许多关于青少年和年轻人痤疮的研究，但大多数是基于医院的。在这些研究中可能会引入实质性的选择偏倚，因为具有更严重疾病症状或体征的患者更有可能寻求医疗护理，并感知到更多受损的生活质量。在中国，基于人群的研究的流行病学数据仍然缺乏。我们的研究旨在估计中国大学生中中度和重度痤疮的患病率，并评估其对生活质量的影响。

致编辑：耳鸣是在没有外界声音的情况下对声音的印象。耳鸣影响10%至15%的成年人，大约20%的耳鸣患者认为这很烦人。^[1]耳鸣的影响在普通人群和退伍军人中是众所周知的。耳鸣会产生焦虑和注意力集中问题，损害脑力劳动能力，难以入睡，并导致抑郁症，严重时会导致自杀，从而降低生活质量。由于人口老龄化、生活节奏加快、建筑和娱乐活动的噪音暴露增加以及一些地区武装冲突的增加，耳鸣的发病率正在增加。然而，缺乏关于耳鸣加重的研究。本研究报告了解决这一差距的耳鸣加重数据，以预防耳鸣相关合并症的发生并改善耳鸣的管理。

致编辑：单侧痣样毛细血管扩张症（UNT）是一种罕见的皮肤血管疾病，其特征是以单侧线性模式分布的浅表毛细血管扩张。它可以是先天性的，也可以是后天性的。UNT的发病机制尚不清楚，大多数学者认为高雌激素状态在UNT中起重要作用。脉冲染料激光（PDL）疗法是一种主流治疗选择。在此，我们提出了一个用海姆泊芬介导的光动力疗法（HMME-PDT）成功治疗PDL耐药UNT的病例。

致编辑：单纯性肝囊肿是胃肠病科和肝病科就诊的常见原因。虽然大多数患者病程为良性，但也有部分患者出现严重并发症，如囊内感染、出血，甚至破裂，或周围组织器官受到严重压迫而引起的症状。了解单纯性肝囊肿的患病率、特点及相关因素有助于更好地治疗有症状的患者。报告的该病患病率差异很大，从2.5%到18.0%不等，大多数是基于医院调查。^[1,2,3,4]单纯性肝囊肿在大多数情况下作为一种无症状的疾病，通常在腹部影像学上偶然发现。因此，基于医院人群的调查不能代表真实的患病率。此外，由于缺乏健康对照，对医院人群的调查无法确定简单肝囊肿的相关因素。^[1,2,3,4]

致编辑：真性红细胞增多症^[1]是一种慢性进行性骨髓增生性肿瘤（MPN），其特征是骨髓细胞的克隆性增殖。这种情况表现为大量异常红细胞增多、白细胞增多和血小板增多，可能导致静脉血栓栓塞。脑静脉窦血栓形成（CVST）是临床上罕见的PV表现。PV的症状在发病时往往是隐匿的，缺乏CVST的特异性临床表现可能导致诊断延迟。迄今为止，由于发病率低和证据有限，PV中CVST的诊断和治疗仍然是一个挑战。在这项研究中，我们提出了五个PV病例杰克2V617F突变，CVST是PV的首发表现。详细特征总结在表1首都医科大学宣武医院伦理委员会批准了本研究（批准号2019119）。作者证明他们已获得所有适当的患者同意书。

致编辑：气管支气管软化症(TBM)是一种由软骨畸形引起的疾病；该畸形由于原发性或继发性原因导致气管或支气管畸形，呼气时横截面缩小≥50%。^[1]TBM的严重程度取决于气道的解剖变化，其被描述为轻度（50%-75%减少）、中度（75%-90%减少）和重度（>90%减少）。^[2]根据以前的研究，已经确定了一系列与TBM有关的原因。^[3]先天性气道软化症可以是许多罕见综合征的一部分，^[4]包括染色体缺陷综合征、再一次基因突变、粘多糖贮积症和遗传性结缔组织疾病。此外，一些情况，如气管食管瘘、血管环、心血管系统畸形、维生素D缺乏和反复感染，被揭示为TBM的次要原因。因此，对于TBM患者来说，区分TBM的病因是重要的，这有助于指导治疗和护理策略。