Volume 134 · Issue 19 · 2021

多基因检测在早期浸润性乳腺癌患者化疗决策中的作用已得到广泛认可。2017年，美国临床肿瘤学会（ASCO）多基因谱分析临床指南重点提高了MammaPrint临床使用的建议强度^®.^[1]2018年正式启动的美国癌症联合委员会（AJCC）分期系统第8版首次确立了预后分期的概念，增加了使用非解剖信息评估预后。最初，Oncotype Dx^®根据I级证据推荐给合适的患者。随后，五种测试技术，Oncotype Dx^®,妈妈打印^®,内预测^®, PAM50^®和BCI被正式纳入系统。^[2]为了帮助中国乳腺疾病专家为患者选择合适的多基因谱分析和检测方法，并在参考多基因分析的决策中灌输谨慎，中国乳腺外科学会（CSBrS）通过文献调查和专家讨论，提供了关于使用多基因分析的关键临床问题和指南的信息，参考建议评估发展和评估（GRADE）系统的等级评估证据。结合这些检测在中国的可用性，制定并发布了多基因检测临床实践指南。本指南旨在为我国乳腺疾病专科临床医师提供参考。

为促进中国乳房切除术后乳房重建的标准化，中国乳腺外科学会（CSBrS）通过文献综述和专家讨论确定了乳房切除术后乳房重建在临床实践中的关键问题，然后根据建议评估、开发和评估建议的分级，并基于中国临床实践的可及性，通过系统评估相关已发表证据，制定了CSBrS乳房切除术后乳房重建临床实践指南（2021版）。该指南为中国乳腺外科医生提供了参考。

自发性脑出血（ICH）是一种严重的危及生命的事件，发病率和死亡率最高。ICH是一种全球性负担，每年影响约200万人。据估计，超过三分之一的ICH患者在发病的第一个月内死亡，40%的幸存者仍然残疾。然而，缺乏针对ICH的循证疗法。^[1]

在考虑抗凝治疗之前，缺血性卒中的风险分层对于房颤（AF）患者至关重要。根据目前的房颤管理指南，约90%的房颤患者应接受抗凝治疗，房颤患者卒中死亡的风险约为68%。因此，准确定义急需抗凝治疗的患者非常重要。在此背景下，Ma的研究结果等人^[1]本期发表的文章可能有助于准确定义真正有中风风险的房颤患者。该研究旨在为中国房颤患者血栓栓塞事件（TEs）（包括缺血性卒中和全身性栓塞事件）的1年风险开发一个准确且易于使用的预测模型。

Accurate prediction of ischemic stroke is required for deciding anticoagulation use in patients with atrial fibrillation (AF). Even though only 6% to 8% of AF patients die from stroke, about 90% are indicated for anticoagulants according to the current AF management guidelines. Therefore, we aimed to develop an accurate and easy-to-use new risk model for 1-year thromboembolic events (TEs) in Chinese AF patients.

From the prospective China Atrial Fibrillation Registry cohort study, we identified 6601 AF patients who were not treated with anticoagulation or ablation at baseline. We selected the most important variables by the extreme gradient boosting (XGBoost) algorithm and developed a simplified risk model for predicting 1-year TEs. The novel risk score was internally validated using bootstrapping with 1000 replicates and compared with the CHA₂DS₂-VA score (excluding female sex from the CHA₂DS₂-VASc score).

Up to the follow-up of 1 year, 163 TEs (ischemic stroke or systemic embolism) occurred. Using the XGBoost algorithm, we selected the three most important variables (congestive heart failure or left ventricular dysfunction, age, and prior stroke, abbreviated as CAS model) to predict 1-year TE risk. We trained a multivariate Cox regression model and assigned point scores proportional to model coefficients. The CAS scheme classified 30.8% (2033/6601) of the patients as low risk for TE (CAS score = 0), with a corresponding 1-year TE risk of 0.81% (95% confidence interval [CI]: 0.41%-1.19%). In our cohort, the C-statistic of CAS model was 0.69 (95% CI: 0.65-0.73), higher than that of CHA₂DS₂-VA score (0.66, 95% CI: 0.62-0.70, Z = 2.01, P = 0.045). The overall net reclassification improvement from CHA₂DS₂-VA categories (low = 0/high ≥1) to CAS categories (low = 0/high ≥1) was 12.2% (95% CI: 8.7%-15.7%).

In Chinese AF patients, a novel and simple CAS risk model better predicted 1-year TEs than the widely-used CHA₂DS₂- VA risk score and identified a large proportion of patients with low risk of TEs, which could potentially improve anticoagulation decision-making.

www.chictr.org.cn (Unique identifier No. ChiCTR-OCH-13003729).

Functional mitral regurgitation (FMR) is common in critically ill patients and may cause left atrial (LA) pressure elevation. This study aims to explore the prognostic impact of synergistic LA pressure elevation and FMR in patients with shock.

We retrospectively screened 130 consecutive patients of 175 patients with shock from April 2016 to June 2017. The incidence and impact of FMR and early diastolic transmitral velocity to early mitral annulus diastolic velocity ratio (E/e’) ≥ 4 within 6 h of shock on the prognosis of patients were evaluated. Finally, the synergistic effect of FMR and E/e’ were assessed by combination, grouping, and trend analyses.

Forty-four patients (33.8%) had FMR, and 15 patients (11.5%) had E/e’ elevation. A multivariate analysis revealed FMR and E/e’ as independent correlated factors for 28-day mortality (P = 0.043 and 0.028, respectively). The Kaplan-Meier survival analysis revealed a significant difference in survival between patients with and without FMR (χ² = 7.672, P = 0.006) and between the E/e’ ≥ 14 and E/e’ < 14 groups (χ² = 19.351, P < 0.010). Twenty-eight-day mortality was significantly different among the four groups (χ² = 30.141, P < 0.010). The risk of 28-day mortality was significantly higher in group 4 (E/e’ ≥ 14 with FMR) compared with groups 1 (E/e’ < 14 without FMR) and 2 (E/e’ < 14 with FMR) (P = 0.001 and 0.046, respectively).

Patients with shock can be identified by the presence of FMR. FMR and E/e’ are independent risk factors for a poor prognosis in these patients, and prognosis is worst when FMR and E/e’ ≥ 14 are present. It may be possible to improve prognosis by reducing LA pressure and E/e’.

ClinicalTrials.gov, NCT03082326.

Existing clinical prediction models for in vitro fertilization are based on the fresh oocyte cycle, and there is no prediction model to evaluate the probability of successful thawing of cryopreserved mature oocytes. This research aims to identify and study the characteristics of pre-oocyte-retrieval patients that can affect the pregnancy outcomes of emergency oocyte freeze-thaw cycles.

Data were collected from the Reproductive Center, Peking University Third Hospital of China. Multivariable logistic regression model was used to derive the nomogram. Nomogram model performance was assessed by examining the discrimination and calibration in the development and validation cohorts. Discriminatory ability was assessed using the area under the receiver operating characteristic curve (AUC), and calibration was assessed using the Hosmer-Lemeshow goodness-of-fit test and calibration plots.

The predictors in the model of "no transferable embryo cycles" are female age (odds ratio [OR] = 1.099, 95% confidence interval [CI] = 1.003-1.205, P = 0.0440), duration of infertility (OR = 1.140, 95% CI = 1.018-1.276, P = 0.0240), basal follicle-stimulating hormone (FSH) level (OR = 1.205, 95% CI = 1.051-1.382, P = 0.0084), basal estradiol (E2) level (OR = 1.006, 95% CI = 1.001-1.010, P = 0.0120), and sperm from microdissection testicular sperm extraction (MESA) (OR = 7.741, 95% CI = 2.905-20.632, P < 0.0010). Upon assessing predictive ability, the AUC for the "no transferable embryo cycles" model was 0.799 (95% CI: 0.722-0.875, P < 0.0010). The Hosmer-Lemeshow test (P = 0.7210) and calibration curve showed good calibration for the prediction of no transferable embryo cycles. The predictors in the cumulative live birth were the number of follicles on the day of human chorionic gonadotropin (hCG) administration (OR = 1.088, 95% CI = 1.030-1.149, P = 0.0020) and endometriosis (OR = 0.172, 95% CI = 0.035-0.853, P = 0.0310). The AUC for the "cumulative live birth" model was 0.724 (95% CI: 0.647-0.801, P < 0.0010). The Hosmer-Lemeshow test (P = 0.5620) and calibration curve showed good calibration for the prediction of cumulative live birth.

The predictors in the final multivariate logistic regression models found to be significantly associated with poor pregnancy outcomes were increasing female age, duration of infertility, high basal FSH and E2 level, endometriosis, sperm from MESA, and low number of follicles with a diameter >10 mm on the day of hCG administration.

Multiple techniques are commonly used for posterior cruciate ligament (PCL) reconstruction. However, the optimum method regarding the fixation of PCL reconstruction after PCL tears remains debatable. The purpose of this study was to compare the biomechanical properties among three different tibial fixation procedures for transtibial single-bundle PCL reconstruction.

Thirty-six porcine tibias and porcine extensor tendons were randomized into three fixation study groups: the interference screw fixation (IS) group, the transtibial tubercle fixation (TTF) group, and TTF + IS group (n = 12 in each group). The structural properties of the three fixation groups were tested under cyclic loading and load-to-failure. The slippage after the cyclic loading test and the stiffness and ultimate failure load after load-to-failure testing were recorded.

After 1000 cycles of cyclic testing, no significant difference was observed in graft slippage among the three groups. For load-to-failure testing, the TTF + IS group showed a higher ultimate failure load than the TTF group and the IS group (876.34 ± 58.78 N vs. 660.92 ± 77.74 N [P < 0.001] vs. 556.49 ± 65.33 N [P < 0.001]). The stiffness in the TTF group was significantly lower than that in the IS group and the TTF + IS group (92.77 ± 20.16 N/mm in the TTF group vs. 120.27 ± 15.66 N/m in the IS group [P = 0.001] and 131.79 ± 17.95 N/mm in the TTF + IS group [P < 0.001]). No significant difference in the mean stiffness was found between the IS group and the TTF + IS group (P = 0.127).

In this biomechanical study, supplementary fixation with transtibial tubercle sutures increased the ultimate failure load during load-to-failure testing for PCL reconstruction.

Age-related macular degeneration (AMD) is the leading cause of vision loss worldwide. However, the mechanisms involved in the development and progression of AMD are poorly delineated. We aimed to explore the critical genes involved in the progression of AMD.

The differentially expressed genes (DEGs) in AMD retinal pigment epithelial (RPE)/choroid tissues were identified using the microarray datasets GSE99248 and GSE125564, which were downloaded from the gene expression omnibus database. The overlapping DEGs from the two datasets were screened to identify DEG-related biological pathways using gene ontology and Kyoto Encyclopedia of Genes and Genomes enrichment analyses. The hub genes were identified from these DEGs through protein-protein interaction network analyses. The expression levels of hub genes were evaluated by quantitative real-time polymerase chain reaction following the induction of senescence in ARPE-19 with FK866. Following the identification of AMD-related key genes, the potential small molecule compounds targeting the key genes were predicted by PharmacoDB. Finally, a microRNA-gene interaction network was constructed.

Microarray analyses identified 174 DEGs in the AMD RPE compared to the healthy RPE samples. These DEGs were primarily enriched in the pathways involved in the regulation of DNA replication, cell cycle, and proteasome-mediated protein polyubiquitination. Among the top ten hub genes, HSP90AA1, CHEK1, PSMA4, PSMD4, and PSMD8 were upregulated in the senescent ARPE-19 cells. Additionally, the drugs targeting HSP90AA1, CHEK1, and PSMA4 were identified. We hypothesize that Hsa-miR-16-5p might target four out of the five key DEGs in the AMD RPE.

Based on our findings, HSP90AA1 is likely to be a central gene controlling the DNA replication and proteasome-mediated polyubiquitination during the RPE senescence observed in the progression of AMD. Targeting HSP90AA1, CHEK1, PSMA4, PSMD4, and/or PSMD8 genes through specific miRNAs or small molecules might potentially alleviate the progression of AMD through attenuating RPE senescence.

A deep learning model (DLM) that enables non-invasive hypokalemia screening from an electrocardiogram (ECG) may improve the detection of this life-threatening condition. This study aimed to develop and evaluate the performance of a DLM for the detection of hypokalemia from the ECGs of emergency patients.

We used a total of 9908 ECG data from emergency patients who were admitted at the Second Affiliated Hospital of Nanchang University, Jiangxi, China, from September 2017 to October 2020. The DLM was trained using 12 ECG leads (lead I, II, III, aVR, aVL, aVF, and V₁-₆) to detect patients with serum potassium concentrations <3.5 mmol/L and was validated using retrospective data from the Jiangling branch of the Second Affiliated Hospital of Nanchang University. The blood draw was completed within 10 min before and after the ECG examination, and there was no new or ongoing infusion during this period.

We used 6904 ECGs and 1726 ECGs as development and internal validation data sets, respectively. In addition, 1278 ECGs from the Jiangling branch of the Second Affiliated Hospital of Nanchang University were used as external validation data sets. Using 12 ECG leads (leads I, II, III, aVR, aVL, aVF, and V₁-₆), the area under the receiver operating characteristic curve (AUC) of the DLM was 0.80 (95% confidence interval [CI]: 0.77-0.82) for the internal validation data set. Using an optimal operating point yielded a sensitivity of 71.4% and a specificity of 77.1%. Using the same 12 ECG leads, the external validation data set resulted in an AUC for the DLM of 0.77 (95% CI: 0.75-0.79). Using an optimal operating point yielded a sensitivity of 70.0% and a specificity of 69.1%.

In this study, using 12 ECG leads, a DLM detected hypokalemia in emergency patients with an AUC of 0.77 to 0.80. Artificial intelligence could be used to analyze an ECG to quickly screen for hypokalemia.

Emerging evidence indicates that the sineoculis homeobox homolog 1-eyes absent homolog 1 (SIX1-EYA1) transcriptional complex significantly contributes to the pathogenesis of multiple cancers by mediating the expression of genes involved in different biological processes, such as cell-cycle progression and metastasis. However, the roles of the SIX1-EYA1 transcriptional complex and its targets in colorectal cancer (CRC) are still being investigated. This study aimed to investigate the roles of SIX1-EYA1 in the pathogenesis of CRC, to screen inhibitors disrupting the SIX1-EYA1 interaction and to evaluate the efficiency of small molecules in the inhibition of CRC cell growth.

Real-time quantitative polymerase chain reaction and western blotting were performed to examine gene and protein levels in CRC cells and clinical tissues (collected from CRC patients who underwent surgery in the Department of Integrated Traditional and Western Medicine, West China Hospital of Sichuan University, between 2016 and 2018, n = 24). In vivo immunoprecipitation and in vitro pulldown assays were carried out to determine SIX1-EYA1 interaction. Cell proliferation, cell survival, and cell invasion were determined using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay, clonogenic assay, and Boyden chamber assay, respectively. The Amplified Luminescent Proximity Homogeneous Assay Screen (AlphaScreen) method was used to obtain small molecules that specifically disrupted SIX1-EYA1 interaction. CRC cells harboring different levels of SIX1/EYA1 were injected into nude mice to establish tumor xenografts, and small molecules were also injected into mice to evaluate their efficiency to inhibit tumor growth.

Both SIX1 and EYA1 were overexpressed in CRC cancerous tissues (for SIX1, 7.47 ± 3.54 vs.1.88 ± 0.35, t = 4.92, P = 0.008; for EYA1, 7.61 ± 2.03 vs. 2.22 ± 0.45, t = 6.73, P = 0.005). The SIX1/EYA1 complex could mediate the expression of two important genes including cyclin A1 (CCNA1) and transforming growth factor beta 1 (TGFB1) by binding to the myocyte enhancer factor 3 consensus. Knockdown of both SIX1 and EYA1 could decrease cell proliferation, cell invasion, tumor growth, and in vivo tumor growth (all P < 0.01). Two small molecules, NSC0191 and NSC0933, were obtained using AlphaScreen and they could significantly inhibit the SIX1-EYA1 interaction with a half-maximal inhibitory concentration (IC₅₀) of 12.60 ± 1.15 μmol/L and 83.43 ± 7.24 μmol/L, respectively. Administration of these two compounds could significantly repress the expression of CCNA1 and TGFB1 and inhibit the growth of CRC cells in vitro and in vivo.

Overexpression of the SIX1/EYA1 complex transactivated the expression of CCNA1 and TGFB1, causing the pathogenesis of CRC. Pharmacological inhibition of the SIX1-EYA1 interaction with NSC0191 and NSC0933 significantly inhibited CRC cell growth by affecting cell-cycle progression and metastasis.

自从神经轴阻滞被发现以来，腰麻被频繁用于剖宫产手术。根据一份关于低血压管理的国际共识声明，Kinsella等人^[1]据报道，产妇脊髓麻醉后低血压的发生率高达70%至80%。腰麻后低血压主要由交感神经血管舒缩阻滞引起，导致全身血管阻力降低，电容性血管内静脉汇集，心输出量减少。严重低血压可能导致母体和胎儿不良事件。不良的母体低血压可能导致子宫血流量减少，导致胎盘灌注减少和胎儿缺氧，导致急性胎儿酸中毒。术前负荷试验阳性的孕妇与剖宫产期间腰麻后低血压的风险增加相关。^[2]然而，负荷试验预测腰麻后低血压的敏感性仅为69%。^[2]在临床实践中，仍然非常需要非侵入性、可靠和容易获得的技术来预测腰麻后低血压的发生率以及改善剖宫产时腰麻诱导的低血压的管理。

再生障碍性贫血（AA）是一种骨髓衰竭综合征，可分为先天性或获得性AA。大多数获得性AA病例是特发性的，其中异常的免疫系统攻击骨髓造血干细胞及其微环境。^[1]一些AA继发于放疗和/或化疗。然而，大多数血细胞减少症可以在停止放化疗后1至2个月内恢复，因为骨髓抑制疗法被设计为可逆的。尽管如此，一些患者在超过3个月的无治疗后未能从造血中恢复。这些患者在仔细检查后被诊断为AA，无法继续他们计划的放化疗，有时患有或死于由严重血细胞减少引起的感染或出血，或原发肿瘤复发。在恶性肿瘤患者中广泛使用骨髓抑制治疗与治疗相关AA的增加有关。不幸的是，目前没有关于这些患者管理的指南或共识。在这项研究中，我们探讨了环孢素A（CsA）在这些患者中的疗效和安全性。

脑室穿刺是一种常见的神经外科手术，通常使用体表解剖标志作为靶向参考徒手进行。^[1,2]然而，据报道，如果使用体表解剖标志作为靶向参考，徒手侧脑室穿刺在创伤性脑损伤病例中的失败率可能高达43%，^[3]脑室穿刺出血发生率可达16.2%。^[4]经典穿刺部位，如Kocher点，有助于提高脑室穿刺成功率。然而，用经典穿刺部位进行徒手穿刺仍然有风险。几个原因可能导致这个问题，包括以下几点：（1）个体患者有不同的情况；适合所有患者的穿刺方法可能是不可能的。（2）穿刺入路的选择很大程度上取决于外科医生的判断，因为穿刺入路通常不会落在常规计算机断层（CT）扫描的冠状、矢状或轴位图像上；外科医生需要使用基于CT图像的空间想象来设计心室穿刺轨迹（VPT），这可能会导致错误。（3）在徒手穿刺中，如果没有作为穿刺路径的固定空间参考的框架的引导，很容易发生方向偏差。

手术机器人已经在手术中得到了广泛的应用。目前，达芬奇手术系统（Intuitive Surgery，Inc.，Sunnyvale，CA，USA）是临床环境中使用的最常见的机器人系统。该系统已被证明可用于隐匿位置的病变，如舌根肿瘤、舌根和颌下腺结石。与传统的开放外科手术相比，它的创伤更小；然而，它是否适合穿刺仍有争议。Remebot（北京百汇维康科技有限公司；中国北京）是一种手术机器人，目前正在用于神经外科手术。基于术中导航，它可以同时帮助外科医生确定穿刺的方向和深度。虽然据报道它可以达到1.330±0.566 mm的精度^[1]在活检手术中，口腔颌面外科领域尚未有相同的报道。因此，为了验证机器人在口腔颌面外科中使用的可行性，我们在本研究中选择穿刺卵圆孔（FO）和茎乳孔（FS）。

致编辑：自1027年首次为医疗从业者介绍显示穴位和经络的天圣铜像以来，它已经演变为中医目前使用的穴位和经络图谱。^[1]迄今为止，穴位代表身体表面上相对于某些标志的限定区域。四肢末端的穴位在解剖学上与各种相关的内脏器官或组织相连，形成经络网络。在地图集上，每条主要经络通常是一条虚拟的线，连接一组与特定内脏器官相关的相邻穴位。在现代医学中，主要经络的解剖结构在很大程度上仍未阐明。

致编辑：具有梭形细胞成分和不典型特征的脂肪瘤性肿瘤是罕见的软组织肿瘤。非典型脂肪瘤(ALT)/高分化脂肪肉瘤(WDLPS)是最常见的脂肪肉瘤之一MDM2(12q13-15)基因扩增。然而，最近一些研究认为，被命名为“非典型梭形细胞脂肪瘤”（ASLT）和非典型多形性脂肪瘤（APLT）的独特脂肪瘤应与WDLPS区分开来，因为它们具有更好的预后。^[1,2]ASLT和APLT是肿瘤RB1基因缺失和与经典梭形细胞脂肪瘤（SCL）/多形性脂肪瘤相同的染色体改变。^[2]最新版《世界卫生组织软组织和骨肿瘤分类，第五版》正式介绍了ASLT/APLT的名称^[3];这些肿瘤在中国患者中很少见，亚洲仅有少数小系列病例报道。

致编辑：Sertoli-Leydig细胞肿瘤（SLCTs）是一种罕见的卵巢性索间质肿瘤，占<占所有卵巢肿瘤的0.5%。^[1]基于临床和病理特征的准确诊断和预后知识具有重要的治疗意义；然而，SLCT的稀有性使得收集可靠的数据变得困难。目的分析SLCT的特点，阐明其与肿瘤行为的关系，探讨合理的治疗模式。

致编辑：衰老与肾功能障碍和心血管疾病风险增加有关。即使在肾功能不全的早期阶段，心血管系统和肾功能之间的联系也是显而易见的。胱抑素C(CYSC)是在所有有核细胞中表达的胱抑素超家族之一，被认为是评价肾功能的最佳指标之一。^[1]CYSC是组织蛋白酶B（CTSB）的有效抑制剂，其在细胞外基质重塑中受到CYSC的严格调节。CYSC和CTSB之间的失衡与动脉粥样硬化（AS）、冠心病和具有衰老相关表型的慢性肾脏疾病有关。我们先前的研究证实，在健康成人中，血清CTSB水平与年龄和心血管肾功能下降有关，^[2]提示CTSB对心血管和肾小球功能的变化表现出高度的敏感性。目前的研究强调了合成和降解途径在衰老过程中的作用，强调了心肾与衰老的相互作用可能部分取决于一些基因的差异表达，导致功能性蛋白质的失衡。在这项研究中，我们分析了中国健康人群中肾功能（通过CYSC和估计的肾小球滤过率（eGFR）测量）与血管参数之间的关系。

致编辑：骨髓间充质干细胞（BMSCs）是研究最多的成体干细胞。然而，BMSCs的缺陷仍然存在，如其纯化率低、数量有限、对人体的创伤等。近年来，一些研究表明，脂肪组织提取物中的一些细胞具有与BMSCs相似的功能，即分化成各种组织的潜力，称为脂肪衍生干细胞（ADSCs）。^[1]与BMSCs相比，ADSCs具有来源更广、采集更容易、患者痛苦更小、增殖迅速、无免疫排斥反应、不涉及道德伦理问题等优点。目前对ADSCs的研究多局限于低等哺乳动物，如兔、小鼠等，对灵长类动物的实验研究报道较少。灵长类动物具有与人类相似的解剖和生理特征，这已成为许多动物实验的热门选择。^[2]本研究的目的是探索猕猴ADSCs的分离方法和潜在的多能分化体外为灵长类ADSCs在再生医学中提供了实验数据和新的见解。

致编辑：根据国家健康和营养检查调查（2007-2010）的数据，美国（US）人群中肾结石的患病率为8.8%。^[1]先前的一项美国人群研究发现，肾结石的患病率随着肥胖、糖尿病和代谢综合征而增加；对于患有2型糖尿病的个体，疾病的严重程度与肾结石的更大风险相关。^[1,2]崔等人^[3]报道称，糖尿病诊断是可能继发于输尿管水肿的自发性结石排出（SSP）失败的重要预测风险因素，应考虑这些糖尿病患者作为更具侵入性治疗的候选人。然而，这项研究仅包括26名糖尿病患者，366名患者中只有31名未能自发排出结石，这两者都可能限制了预测糖尿病SSP的能力。^[3]考虑到美国结石的数量以及患者组之间SSP率变化的后果，这是一个需要回答的重要问题。因此，通过对克利夫兰诊所基金会急诊肾绞痛就诊数据库的回顾性分析，我们评估了糖尿病与SSP的相关性，并调查了糖尿病患者SSP的预测因素。

致编辑：由于普通人群卒中的患病率比2型糖尿病（T2DM）患者低2至3倍，其中卒中占所有死亡的11.0%，卒中显然是增加T2DM患者死亡率和发病率的主要大血管并发症。^[1]中风的病理生理学由涉及氧化应激、内皮功能障碍和促炎反应的复杂过程组成。CD36是一种B清道夫受体，参与炎症、先天免疫和脂质代谢，并与动脉粥样硬化的病理生理学有关。^[2]然而，没有研究根据疾病持续时间评估CD36多态性对T2DM患者的影响。因此，本研究根据病程评估了韩国T2DM患者rs1761667 CD36单核苷酸多态性（SNP）与卒中之间的关系。

致编辑：乙型肝炎病毒（HBV）感染是与肝脏相关的发病率和死亡率相关的主要全球健康问题。慢性HBV感染，定义为乙型肝炎表面抗原（HBsAg）阳性，影响全球约2.57亿人。慢性HBV感染可导致肝硬化、肝衰竭和肝细胞癌（HCC）的发展。肝移植（LT）仍然是治疗HBV相关终末期肝病的唯一治疗方法。^[1]

致编辑人口老龄化的全球趋势和冠心病（CHD）的流行导致CHD患者的非心脏手术量增加。^[1,2]对于对增加的心脏负荷和减少的氧气输送几乎没有耐受性的CHD患者来说，血流动力学参数的剧烈波动可能危及生命。^[3]全麻后肌松残余麻痹可能导致低氧血症伴呼吸肌无力，加重患者紧张。胆碱酯酶抑制剂新斯的明通常用于逆转全身麻醉手术后的神经肌肉阻滞（NMB）。然而，在CHD患者中联合使用新斯的明和阿托品可能存在潜在的问题，因为副作用，如心肌缺血、心律失常或房室传导阻滞。^[4]Sugammadex是一种新的NMB逆转剂，对类固醇肌肉松弛剂，特别是罗库溴铵具有选择性。然而，舒更葡糖对CHD患者恢复情况的影响尚未完全阐明。

致编辑：肠道微生物群，即生活在人类和啮齿动物肠道中的数万亿微生物，在心血管疾病（包括高血压和动脉粥样硬化）中起着关键作用。心血管疾病中肠道微生物群功能的关键机制之一是微生物群衍生的代谢物，如短链脂肪酸（SCFAs）。新出现的证据表明，肠道微生物群衍生的代谢物——SCFAs可以维持稳定的血压。^[1]然而，没有关于SCFAs与高血压相关性的大型队列研究。