Volume 134 · Issue 14 · 2021

人血清白蛋白（HSA）是一种非糖基化、带负电荷的单链多肽，由585个氨基酸残基组成，相对分子质量为66.438 kD。它由肝脏以大约200 mg·kg的速率合成^-1·日^-1半衰期为21天，在肌肉、肝脏和肾脏中以每天4%的速率分解代谢。^[1]

乳腺癌是我国女性中最常见的恶性肿瘤。于二零一五年，中国新诊断出约304,000例乳腺癌病例，在癌症诊断中排名第一，佔女性所有新癌症的17.1%。^[1,2]美国预防服务工作组（USPSTF）^[3]和国家综合癌症网络（NCCN）临床实践指南^[4]提出了关于风险评估的建议，以确定乳腺癌风险增加的妇女，应为她们提供基于风险的癌症筛查和/或降低风险的药物使用，以降低个人乳腺癌风险。

乳腺导管内乳头状瘤比较常见，占所有乳腺良性疾病的5.3%。^[1]然而，随着病理改变如不典型导管增生（ADH）和癌变容易复发，活检诊断低估率高。^[2,3]因此，导管内乳头状瘤的诊断和治疗方法需要特定的考虑，这些方法的一些临床问题仍然存在争议。为规范乳腺导管内乳头状瘤的诊断和治疗，为乳腺专科医师的临床工作提供参考，中国乳腺外科学会通过文献检索和专家讨论，确定了乳腺导管内乳头状瘤临床实践指南的临床关键问题。参考建议评估、发展和评估（等级）系统的分级评估相关证据，以及导管内乳头状瘤临床实践指南：中国乳腺外科学会（CSBrS）实践指南2021为我国乳腺外科医生的临床工作提供参考。

The neoadjuvant chemotherapy is increasingly used in advanced gastric cancer, but the effects on safety and survival are still controversial. The objective of this meta-analysis was to compare the overall survival and short-term surgical outcomes between neoadjuvant chemotherapy followed by surgery (NACS) and surgery alone (SA) for locally advanced gastric cancer.

Databases (PubMed, Embase, Web of Science, Cochrane Library, and Google Scholar) were explored for relative studies from January 2000 to January 2021. The quality of randomized controlled trials and cohort studies was evaluated using the modified Jadad scoring system and the Newcastle-Ottawa scale, respectively. The Review Manager software (version 5.3) was used to perform this meta-analysis. The overall survival was evaluated as the primary outcome, while perioperative indicators and post-operative complications were evaluated as the secondary outcomes.

Twenty studies, including 1420 NACS cases and 1942 SA cases, were enrolled. The results showed that there were no significant differences in overall survival (P = 0.240), harvested lymph nodes (P = 0.200), total complications (P = 0.080), and 30-day post-operative mortality (P = 0.490) between the NACS and SA groups. However, the NACS group was associated with a longer operation time (P < 0.0001), a higher R0 resection rate (P = 0.003), less reoperation (P = 0.030), and less anastomotic leakage (P = 0.007) compared with SA group.

Compared with SA, NACS was considered safe and feasible for improved R0 resection rate as well as decreased reoperation and anastomotic leakage. While unbenefited overall survival indicated a less important effect of NACS on long-term oncological outcomes.

脊髓损伤（Spinal cord injury，SCI）是中枢神经系统常见的创伤性疾病；给患者造成严重的生理和心理伤害，给整个社会造成巨大的经济负担。^[1]SCI治疗的严峻形势需要进一步探索其机制并获得新的治疗策略。

“大数据”一词起源于第11届电子材料大会世界年会上，原指技术应用产生的大量数据。^[1]医疗大数据不仅包括患者住院期间积累的病史和检查数据，还包括来自门诊、急诊、医保结算部门以及临床实验中心的患者相关随访数据、预后数据。迄今为止，它在医学的各个专业都有深刻的应用。^[2,3,4]然而，重症监护医学（ICU）不同于其他医疗领域。与临床实践数据相比，ICU医疗数据具有以下特点：规模大、生产快、维度多样、不准确性、异质性、不完整性、复杂性和隐私问题。^[5]事实上，在国内和全球各大ICU数据库的建设过程中，都对这些数据库进行了大篇幅的优化。以异构为例，医疗数据可能的格式包括文本类型、数字类型和图像类型。基于文本的数据包括人口统计学特征、药物使用、病史和症状。数字数据包括各种实验室检测结果、生命体征、监测仪器数据。图像类型数据包括各种成像评估，例如B型超声、计算机断层扫描、磁共振成像、X射线和其他检查。在数据库的形成中，需要文本类型数据的标准化格式。对于数字化数据，强调采集的时效性，并考虑治疗方法和各种指标的趋势。对于图像数据，除了常规的成像报告之外，还可以通过结合诊断和图像特征来建立人工智能图像读取模型。到目前为止，中国在重症医学领域尚未达成行业标准共识。中国卫生信息与健康医疗大数据学会重症医学分会成立于2019年3月，旨在建立和推广重症医疗大数据应用。经过全面调查，发现ICU数据库建设数量和质量有限。应该做出更多的努力来改善这种情况。我们坚信，中国重症数据库的发展将充分利用大数据平台，为患者提供更好的诊断和治疗流程，为管理决策者提供准确客观的诊断，为医学研究人员提供更高质量的数据。

Computed tomography images are easy to misjudge because of their complexity, especially images of solitary pulmonary nodules, of which diagnosis as benign or malignant is extremely important in lung cancer treatment. Therefore, there is an urgent need for a more effective strategy in lung cancer diagnosis. In our study, we aimed to externally validate and revise the Mayo model, and a new model was established.

A total of 1450 patients from three centers with solitary pulmonary nodules who underwent surgery were included in the study and were divided into training, internal validation, and external validation sets (n = 849, 365, and 236, respectively). External verification and recalibration of the Mayo model and establishment of new logistic regression model were performed on the training set. Overall performance of each model was evaluated using area under receiver operating characteristic curve (AUC). Finally, the model validation was completed on the validation data set.

The AUC of the Mayo model on the training set was 0.653 (95% confidence interval [CI]: 0.613-0.694). After re-estimation of the coefficients of all covariates included in the original Mayo model, the revised Mayo model achieved an AUC of 0.671 (95% CI: 0.635-0.706). We then developed a new model that achieved a higher AUC of 0.891 (95% CI: 0.865-0.917). It had an AUC of 0.888 (95% CI: 0.842-0.934) on the internal validation set, which was significantly higher than that of the revised Mayo model (AUC: 0.577, 95% CI: 0.509-0.646) and the Mayo model (AUC: 0.609, 95% CI, 0.544-0.675) (P < 0.001). The AUC of the new model was 0.876 (95% CI: 0.831-0.920) on the external verification set, which was higher than the corresponding value of the Mayo model (AUC: 0.705, 95% CI: 0.639-0.772) and revised Mayo model (AUC: 0.706, 95% CI: 0.640-0.772) (P < 0.001). Then the prediction model was presented as a nomogram, which is easier to generalize.

After external verification and recalibration of the Mayo model, the results show that they are not suitable for the prediction of malignant pulmonary nodules in the Chinese population. Therefore, a new model was established by a backward stepwise process. The new model was constructed to rapidly discriminate benign from malignant pulmonary nodules, which could achieve accurate diagnosis of potential patients with lung cancer.

Glucose control is an important aspect in managing critically ill patients. The goal of this study was to compare the effects of sequential feeding (SF) and continuous feeding (CF) on the blood glucose of critically ill patients.

A non-inferiority randomized controlled trial was adopted in this study. A total of 62 patients who were fed enteral nutritional suspension through gastric tubes were enrolled. After achieving 80% of the nutrition target calories (25 kcal·kg^-1·day^-1) through CF, the patients were then randomly assigned into SF and CF groups. In the SF group, the feeding/fasting time was reasonably determined according to the circadian rhythm of the human body as laid out in traditional Chinese medicine theory. The total daily dosage of the enteral nutritional suspension was equally distributed among three time periods of 7 to 9 o’clock, 11 to 13 o’clock, and 17 to 19 o’clock. The enteral nutritional suspension in each time period was pumped at a uniform rate within 2 h by an enteral feeding pump. In the CF group, patients received CF at a constant velocity by an enteral feeding pump throughout the study. Blood glucose values at five points (6:00/11:00/15:00/21:00/1:00) were monitored and recorded for seven consecutive days after randomization. Enteral feeding intolerance was also recorded. Non-inferiority testing was adopted in this study, the chi-square test or Fisher test was used for qualitative data, and the Mann-Whitney U test was used for quantitative data to determine differences between groups. In particular, a repeated measure one-way analysis of variance was used to identify whether changes in glucose value variables across the time points were different between the two groups.

There were no significant demographic or physiological differences between the SF and CF groups (P > 0.050). The average glucose level in SF was not higher than that in CF (8.8 [7.3-10.3] vs. 10.7 [9.1-12.1] mmol/L, Z = -2.079, P for non-inferiority = 0.019). Hyperglycemia incidence of each patient was more common in the CF group than that in the SF group (38.4 [19.1-63.7]% vs. 11.8 [3.0-36.7]%, Z = -2.213, P = 0.027). Hypoglycemia was not found in either group. Moreover, there was no significant difference during the 7 days in the incidence of feeding intolerance (P > 0.050).

In this non-inferiority study, the average blood glucose in SF was not inferior to that in CF. The feeding intolerance in SF was similar to that in CF. SF may be as safe as CF for critically ill patients.

ClinicalTrials.gov, NCT03439618; https://clinicaltrials.gov/ct2/show/record/NCT03439618

The basis of individualized treatment should be individualized mortality risk predictive information. The present study aimed to develop an online individual mortality risk predictive tool for acute-on-chronic liver failure (ACLF) patients based on a random survival forest (RSF) algorithm.

The current study retrospectively enrolled ACLF patients from the Department of Infectious Diseases of The First People’s Hospital of Foshan, Shunde Hospital of Southern Medical University, and Jiangmen Central Hospital. Two hundred seventy-six consecutive ACLF patients were included in the present study as a model cohort (n = 276). Then the current study constructed a validation cohort by drawing patients from the model dataset based on the resampling method (n = 276). The RSF algorithm was used to develop an individual prognostic model for ACLF patients. The Brier score was used to evaluate the diagnostic accuracy of prognostic models. The weighted mean rank estimation method was used to compare the differences between the areas under the time-dependent ROC curves (AUROCs) of prognostic models.

Multivariate Cox regression identified hepatic encephalopathy (HE), age, serum sodium level, acute kidney injury (AKI), red cell distribution width (RDW), and international normalization index (INR) as independent risk factors for ACLF patients. A simplified RSF model was developed based on these previous risk factors. The AUROCs for predicting 3-, 6-, and 12-month mortality were 0.916, 0.916, and 0.905 for the RSF model and 0.872, 0.866, and 0.848 for the Cox model in the model cohort, respectively. The Brier scores were 0.119, 0.119, and 0.128 for the RSF model and 0.138, 0.146, and 0.156 for the Cox model, respectively. The nonparametric comparison suggested that the RSF model was superior to the Cox model for predicting the prognosis of ACLF patients.

The current study developed a novel online individual mortality risk predictive tool that could predict individual mortality risk predictive curves for individual patients. Additionally, the current online individual mortality risk predictive tool could further provide predicted mortality percentages and 95% confidence intervals at user-defined time points.

According to the amyloid, tau, neurodegeneration research framework classification, amyloid and tau positive (A+T+) mild cognitive impairment (MCI) individuals are defined as prodromal Alzheimer disease. This study was designed to compare the clinical and biomarker features between A+T+MCI individuals who progressed to progressive MCI (pMCI) and those who remained stable MCI (sMCI), and to identify relevant baseline clinical biomarker and features that could be used to predict progression to dementia within 2 years.

We stratified 197 A+T+MCI individuals into pMCI (n = 64) and sMCI (n = 133) over 2 years. Demographics and cognitive assessment scores, cerebrospinal fluid (CSF), and neuroimaging biomarkers (¹⁸F-florbetapir positron emission tomography mean standardized uptake value ratios [SUVR] and structural magnetic resonance imaging [MRI]) were compared between pMCI and sMCI at baseline, 12- and 24-month follow-up. Logistic regression models then were used to evaluate clinical baseline and biomarker features that predicted dementia progression in A+T+MCI.

pMCI individuals had higher mean ¹⁸F-florbetapir SUVR, CSF total-tau (t-tau), and p-tau_181P than those in sMCI individuals. pMCI individuals performed poorer in cognitive assessments, both global and domain specific (memory, executive, language, attention, and visuospatial skills) than sMCI. At baseline, there were significant differences in regions of interest of structural MRI between the two groups, including bilateral amygdala, hippocampus and entorhinal, bilateral inferior lateral ventricle, left superior and middle temporal, left posterior and caudal anterior cingulate (P < 0.05). Baseline CSF t-tau levels and cognitive scores of Montreal cognitive assessment, functional assessment questionnaire, and everyday cognition by the patient’s study partner language domain could predict progression to dementia in A+T+MCI within 2 years.

In future clinical trials, specific CSF and cognitive measures that predict dementia progression in A+T+MCI might be useful risk factors for assessing the risk of dementia progression.

Geriatric hip fracture patients receiving clopidogrel are a surgical challenge. In China, most of these patients undergo delayed surgical treatment after clopidogrel withdrawal for at least 5 to 7 days. However, delayed surgery is associated with increased complications and mortality in the older adults. This retrospective paralleled comparison study investigated the safety of early surgery for geriatric hip fracture patients within 5 days of clopidogrel withdrawal.

Acute hip fracture patients (≥65 years) who were hospitalized in the orthogeriatric co-management ward of Beijing Jishuitan Hospital between November 2016 and April 2018 were retrospectively reviewed. Sixty patients taking clopidogrel before injury and discontinued <5 days before surgery constituted the clopidogrel group. The control group constituted 60 patients not taking antiplatelet or anticoagulant drugs and matched 1:1 with the clopidogrel group for sex, fracture type, operative procedure, and time from injury to operation (±10 h). The primary outcome was perioperative blood loss and the secondary outcomes were transfusion requirement, complications, and mortality. The Student’s t test or Wilcoxon signed rank sum test was used for continuous variables and the Chi-square test was used for categorical variables.

Age, body mass index, American Society of Anesthesiologists score, and percentage undergoing general anesthesia were comparable between the groups (P > 0.050). The percentages of patients with coronary heart disease (61.7% vs. 18.3%; P < 0.001) and cerebrovascular disease (45.0% vs. 15.0%; P < 0.010) were significantly higher in the clopidogrel vs. control groups, respectively. The median clopidogrel discontinuation time before operation was 73.0 (range: 3.0-120.0) h. There was no significant difference in the estimated perioperative blood loss between the clopidogrel group (median: 745 mL) and control group (median: 772 mL) (P = 0.866). The intra-operative transfusion rate was higher in the clopidogrel group (22/60, 36.7%) than that in the control group (12/60, 20.0%) (P < 0.050). However, there was no significant difference in the blood transfusion rate during the entire perioperative period (26/60, 43.3% vs. 20/60, 33.3%; clopidogrel group vs. control group, respectively; P > 0.050). There was no significant difference in perioperative complications, and 30-day and 1-year mortality rates between the groups.

Early hip fracture surgery is safe for elderly patients within 5 days of clopidogrel withdrawal, without increased perioperative blood loss, transfusion requirement, complications, and mortality compared with patients not taking antiplatelet drugs.

Reports evaluating the efficacy of transcranial sonography (TCS) for the differential diagnosis of Parkinson disease (PD) and other movement disorders in China are scarce. Therefore, this study aimed to assess the application of TCS for the differential diagnosis of PD, multiple system atrophy (MSA), progressive supranuclear palsy (PSP), and essential tremor (ET) in Chinese individuals.

From 2017 to 2019, 500 inpatients treated at the Department of Dyskinesia, Beijing Tiantan Hospital, Capital Medical University underwent routine transcranial ultrasound examination. The cross-sections at the midbrain and thalamus levels were scanned, and the incidence rates of substantia nigra (SN) positivity and the incidence rates of lenticular hyperechoic area were recorded. The echo of the SN was manually measured.

Of the 500 patients, 125 were excluded due to poor signal in temporal window sound transmission. Among the 375 individuals with good temporal window sound transmission, 200 were diagnosed with PD, 90 with ET, 50 with MSA, and 35 with PSP. The incidence rates of SN positivity differed significantly among the four patient groups (χ² = 121.061, P < 0.001). Between-group comparisons were performed, and the PD group showed a higher SN positivity rate than the ET (χ² = 94.898, P < 0.017), MSA (χ² = 57.619, P < 0.017), and PSP (χ² = 37.687, P < 0.017) groups. SN positivity showed a good diagnostic value for differentiating PD from the other three movement diseases, collectively or individually. The incidences of lenticular hyperechoic area significantly differed among the four patient groups (χ² = 38.904, P < 0.001). Next, between-group comparisons were performed. The lenticular hyperechoic area was higher in the PD group than in the ET (χ² = 6.714, P < 0.017) and MSA (χ²= 18.680, P < 0.017) groups but lower than that in the PSP group (χ² = 0.679, P > 0.017).

SN positivity could effectively differentiate PD from ET, PSP, and MSA in a Chinese population.

脓毒症涉及促炎和抗炎反应的早期激活，但也伴有非免疫途径的重大变化。^[1]自噬是清除受损蛋白质和细胞器的溶酶体依赖性过程。^[2]积累证据体外和体内研究表明，自噬可能对脓毒症具有保护作用，自噬的晚期抑制与不良结局相关。^[3]因此，逆转晚期自噬可能是脓毒症的良好治疗策略。因此，可以为自噬损伤的临床诊断提供信息的生物标志物的鉴定对于指导脓毒症患者的管理将是必不可少的。微管相关蛋白轻链3 II型(LC3 β)是自噬的关键蛋白。^[2]先前的一项研究表明，脓毒症诱导的心肌功能障碍（SIMD）患者的血清LC3 β水平显著低于非SIMD患者，^[4]表明该分子在脓毒症过程中作为病理生理学生物标志物的潜在用途。鉴于这些先前的发现，本研究旨在研究LC3 β蛋白作为自噬相关生物标志物在根据疾病进展分层的脓毒症患者队列中的潜在作用。此外，在同一患者样品中，测量白细胞介素1 β(IL-1 β)和白细胞介素18(IL-18)的血清水平作为促炎细胞因子的指标。

碳青霉烯类耐药的全球蔓延肺炎克雷伯菌（CRKP）由于治疗选择有限和预后不良，已成为主要的医疗负担，这种情况在入住重症监护室（ICU）的患者中变得更糟。^[1]CRKP可引起一系列感染，包括肺炎、尿路感染（UTI）和血流感染（BSI）。BSI是由CRKP引起的最严重的感染之一，与39%至82%的高死亡率相关。^[2]CRKP引起的BSI可以是原发性感染或继发性感染，其起源于肺或膀胱的原发性感染，并且50%的CRKP-BSI起源于肺的原发性感染。^[3]尽管先前的研究已经探索了CRKP感染的几个危险因素，但CRKP肺炎和继发性CRKP-BSI发展之间的联系迄今为止尚未完全揭示。本研究的目的是预测CRKP引起的ICU获得性肺炎28天死亡率和继发性CRKP-BSI发展的危险因素。

横纹肌溶解症是一种严重的临床综合征，当受损的横纹肌分解，细胞内肌肉成分渗漏到血液中时发生。急性肾损伤（AKI）是横纹肌溶解症最常见的并发症。患有AKI的横纹肌溶解症患者的死亡率高于没有AKI的患者。此外，据报道AKI是横纹肌溶解症死亡率的独立预测因子。^[1]因此，早期识别患有AKI的横纹肌溶解症患者或具有发生AKI高风险的患者对于启动积极的治疗干预是必要的。

人类白细胞抗原(HLA)是人类的主要组织相容性复合物。先前的研究表明，高分辨率HLA匹配可以减少移植物vs宿主疾病和改善造血干细胞移植（HSCT）的结局。当患者没有HLA相同的同胞供体时，无关供体HSCT非常重要。然而，每个患者找到可用的无关供体的机会并不相等。西方国家先前的研究发现，HLA单倍型频率（HF）有助于预测识别HLA等位基因匹配的无关供体的概率。^[1]然而，HLA系统显示了种族多样性和地区差异。因此，想要在中国使用HLA单倍型工具，需要建立可靠的中国人群HLA单倍型数据库。

致编辑：贫血是重症监护病房(ICU)患者的常见发现，近60%的ICU患者血清血红蛋白水平<基线时为12 g/dL，其中30%的患者血清血红蛋白水平<9 g/dL，超过95%的危重患者在入住ICU 3天内贫血。^[1]此外，危重患者在ICU住院期间可能会加重或新发展贫血。

致编辑：在过去的几十年里，全球至少有3150万脓毒症患者。在这些患者中，每年有530万败血症患者面临死亡。^[1]研究表明，遵守存活脓毒症运动指南可以降低脓毒症的死亡率_ssc).^[2]遵守指南取决于医疗团队的执行力。我们假设重症监护室的医疗质量_ICU）将对C产生重要影响_ssc.

致编辑：腹膜后出血是一种急性腹部并发症，常见于外伤、医源性手术损伤、肿瘤或肾脏等实体器官破裂。^[1]自发性腹膜后出血（SRH），即腹膜后血管的自发性破裂，其特点是诊断率低，死亡率高。接受治疗性抗凝和透析并患有肾细胞癌的患者的SRH发生率分别为0.6%至6.6%、0.9%和0.3%至1.4%。然而，SRH在没有这些条件的个体中非常罕见。^[1]本研究旨在报告一例伴有肾衰竭和急性左心衰竭的SRH病例。

致编辑：脑小血管疾病（CSVD）是指广泛的病理过程，其影响大脑中的小动脉、小动脉、静脉和毛细血管。这种疾病导致认知、心理和身体残疾，是老年人中高达45%的血管性痴呆的原因。随着人类预期寿命的延长，老年认知障碍的医疗费用和家庭负担日益加重，CSVD的早期识别和有效治疗日益受到重视。

致编辑：宫颈癌（CC）是全世界女性癌症死亡的主要原因之一。^[1]在临床实践中，筛查方法如人乳头瘤病毒检测和基于细胞学的检测具有假阳性率高、滞后或无效的缺点。^[2]非常需要能够以更高的特异性和敏感性帮助诊断CC的新型非侵入性生物标志物。微小RNA(miRNA)是一种长度为18至25个核苷酸的非编码小RNA。循环miRNA在外周血清或血浆中稳定存在，显示出作为癌症生物标志物的巨大潜力。^[3]在这项研究中，我们使用总共108份CC和108份正常对照（NC）血清样本进行了一项四阶段实验，以探索血清miRNAs在CC中的诊断潜力。实验程序的示意图如补充图1所示，http://links.lww.com/CM9/A429。

致编辑：医学上无法解释的身体症状（MUPS）和相关疾病在寻求医疗保健的人群中尤其常见。最近的一项荟萃分析显示，初级保健患者中躯体形式障碍的患病率为34.8%（根据国际疾病分类）和26.2%（根据精神障碍诊断和统计手册[DSM]）。此外，使用问卷在40%至49%的初级保健患者中检测到至少一种医学上无法解释的症状。^[1]

致编辑：84只6周龄雄性Wistar大鼠，体重120~180 g，分为三组：正常对照组(NC)、二乙基亚硝胺(DEN)组和多重应激组。在NC组中，将大鼠维持在相对湿度为60%至80%的室温下，并用正常饮食和饮用水喂养。在DEN组中，大鼠维持与NC组相同，但每天喂食补充0.1 mg/mL DEN的无菌饮用水，持续20周。在多重应激组中，将大鼠维持在5-7℃，相对湿度为25%-32.8%。然后，每天通过食物垫将大鼠暴露于电刺激（第一周在35 V下30分钟，第二周在40 V下35分钟，第三周在45 V下45分钟）。他们还被迫每周一次在15至25°C的水中游泳5分钟，以建立多重应激模型。每天通过饮用水用0.1 mg/mL DEN治疗大鼠，持续20周以诱导肝癌。直至实验结束，NC组存活22只，DEN组存活16只，多重应激组存活10只。在DEN治疗后20周，在麻醉下通过颈椎脱位处死大鼠。本研究由新疆医科大学第一附属医院动物伦理委员会批准（编号：IACUC-20150225-128）。切除肝组织并固定在10%甲醛溶液中，然后成像【补充图1，http：//links.lww.com/CM9/A544】并用苏木精和伊红（H&E）染色。肝脏解剖和H&E染色表明，NC组大鼠的肝脏没有表现出癌症症状[图1A上图]，而DEN组大鼠显示肝细胞组织不规则或坏死、明显的假肝小叶和肝纤维化[图1A，中间面板]。有趣的是，与NC和DEN组相比，多重应激组的大鼠肝癌发病率明显较高。所有大鼠（N=10）在多重应激组中发生肝细胞癌或胆管上皮癌，这表明癌细胞和肝组织部分转化为纤维化。

在文章“超声引导区域麻醉中的单操作者技术”中。134，第6期，第735页中华医学杂志,^[1]该工作得到了“中央高校基础研究基金（编号3331019031）”的支持，应更正为“中央高校基础研究基金（编号3332019031）”。